Melasma Improving Spontaneously upon Switching from a Combined Oral Contraceptive to a Hormone-releasing Intrauterine Device: A Report of Four Cases.

Melasma is a common acquired hypermelanosis of the skin that has been associated with several etiologic factors including ultraviolet light exposure, pregnancy, and oral contraceptives (OCPs) (1). Forty-one percent of women surveyed in one study had onset of melasma after pregnancy, and 25% after starting an OCP (2). Women who develop melasma during pregnancy may be more susceptible to developing melasma while on OCPs (1). OCP use has been an aggravating factor for melasma in several clinico-epidemiologic studies (3), and melasma was noted as rampant with the use of the very first combined oral contraceptives (COCPs) (4, 5). Although the association between melasma with OCP use has been well established, melasma associated with a hormone-releasing intrauterine device (IUD) has not been reported in the medical databases. Herein, we report 4 patients whose melasma, which initially occurred while taking (COCPs, improved after switching to a levonorgestrel (LNG)-releasing IUD (LNG-IUD) (6).