Melasma and prolonged oral contraceptive use: a community-based retrospective cohort study
Abstract
Background: Melasma is a common skin disorder often influenced by hormonal factors such as estrogen and progesterone. Combined oral contraceptives (COCs), which contain both hormones, are widely used in Indonesia and may contribute to melasma, especially among long-term users.
Objective: This study aimed to examine the association between prolonged COC use and melasma among women in Lamongan Regency, Indonesia.
Methods: Using a retrospective cohort design, 20 reproductive-aged women were selected through purposive sampling. Data were collected via structured interviews and clinical observation, and analyzed using the Chi-square test.
Results: Results showed that 55% of participants developed melasma, with a significant association between COC use duration and melasma occurrence (p = 0.024). Women who used combined oral contraceptives for ≥3 years showed a trend toward higher odds of developing melasma compared to those who used COCs for <3 years (OR = 8.0; p= 0.024.
Conclusion: These findings underscore the need for integrating dermatological considerations into contraceptive counseling, particularly in primary healthcare facilities.
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References
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24. Putri IN, Putra AP, Juniano N, et al. The Effect of Sunscreen Use on The Incidence of Melasma in Police Officers: Meta-Analysis and Systemic Review. IIMJ. 2024;6(2):12-24. doi:10.33086/iimj.v6i2.6257
25. Azzahra CN, Widyawati W, Afriliana L, Dewantiningrum J. Melasma Show Up in Contraceptive Pills Acceptors. DMJ. 2021;10(1):74-77. doi:10.14710/dmj.v10i1.29436
26. Ibrahim SA, Kang BY, Schlessinger DI, et al. Protocol for development of a core outcome set for clinical trials in melasma. BMJ Open. 2022;12(2):e046953. doi:10.1136/bmjopen-2020-046953
2. Otto AK, Klein DA, Lau M, Dhar CP, Hwang LY. Over-the-counter access to hormonal contraception: a global perspective. Current Opinion in Pediatrics. 2024;36(4):382-388. doi:10.1097/MOP.0000000000001346
3. Ejaz A, Yasin A, Iqbal A, et al. Prevalence of Contraception in Southeast Asia. Journal of Society of Prevention Advocacy, and Research KEMU. 2022;1(Special Issue). https://journalofspark.com/journal/index.php/JSpark/article/view/87
4. Arimurti JD, Herbawani CK, Hanifah L, Ardhiyanti LP. Factors Influencing The Choice of Female Sterilization Among Women of Reproductive Age in Bojonggede District, Bogor Regency. JKB. 2024;9(2):88-99. doi:10.37306/xxh0kd66
5. Anis W, Dewi ER, Ulhaq RA, et al. Use of contraceptives in a high-income population: a cross-sectional study in Indonesia. British Journal of Midwifery. 2023;31(9):496-501. doi:10.12968/bjom.2023.31.9.496
6. Westhoff CL, Heartwell S, Edwards S, et al. Oral contraceptive discontinuation: do side effects matter? American Journal of Obstetrics and Gynecology. 2007;196(4):412.e1-412.e7. doi:10.1016/j.ajog.2006.12.015
7. Qu Y, Wang S, Xie H, Meng X, Cui B, Xiao Z. Melasma secondary to drugs: a real-world pharmacovigilance study of the FDA adverse event reporting system (FAERS). BMC Pharmacol Toxicol. 2025;26(1):73. doi:10.1186/s40360-025-00912-4
8. Platsidaki E, Markantoni V, Nicolaidou E, et al. Melasma: A Clinical and Epidemiological Single-Group Observational Study in the Greek Population. Dermatol Ther (Heidelb). 2024;14(11):3183-3192. doi:10.1007/s13555-024-01297-8
9. Espósito ACC, Cassiano DP, Da Silva CN, et al. Update on Melasma—Part I: Pathogenesis. Dermatol Ther (Heidelb). 2022;12(9):1967-1988. doi:10.1007/s13555-022-00779-x
10. Mahdalena I, Jusuf NK, Putra IB. Melasma characteristic in hormonal contraceptive acceptors at Kelurahan Mangga Kecamatan Medan Tuntungan, Medan-Indonesia. Bali Med J. 2018;7(3). doi:10.15562/bmj.v7i3.1000
11. Eigbokhan Gilbert Ogbewele, Akachukwu Obianuju Mbata, Nelly Tochi Nwosu. Advancing pharmaceutical care in rural and underserved communities: Strategies for improving global healthcare access. Int j appl res soc sci. 2024;6(10):2447-2461. doi:10.51594/ijarss.v6i10.1641
12. Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb). 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1
13. Hoffman SR, Smith JS, Funk MJ, et al. Combined oral contraceptive utilization and uterine fibroid incidence: A prospective study in a cohort of African-American women. Arafa HMM, ed. PLoS ONE. 2024;19(5):e0303823. doi:10.1371/journal.pone.0303823
14. Res C. Abstract P2-11-18: Weekly evaluation of α estrogen and progesterone receptors in women´s breast epithelium after oral combined hormonal contraceptive use for one month. Cancer Research. 2022;82(4_Supplement):P2-11-18-P2-11-18. doi:10.1158/1538-7445.SABCS21-P2-11-18
15. Wijaya H, Winaya KK, Puspawati NMD, Praharsini I, Darmaputra I, Karna RV. Kadar luteinizing hormone yang tinggi menjadi faktor risiko melasma pada pria. Intisari Sains Medis. 2023;14(1):168-175. doi:10.15562/ism.v14i1.1486
16. McLeod SD, Ranson M, Mason RS. Effects of estrogens on human melanocytes in vitro. The Journal of Steroid Biochemistry and Molecular Biology. 1994;49(1):9-14. doi:10.1016/0960-0760(94)90295-X
17. Sator PG, Sator M, Schmidt J, Huber J, Hönigsmann H. Messung der Hautdicke mittels Hochfrequenzultraschall zur Objektivierung einer Hormonersatztherapie in der Perimenopause. Ultraschall in Med. 2001;22(05):219-224. doi:10.1055/s-2001-17897
18. Baziad A. Effects of continuous Hormone Replacement Therapy (HRT) on FSH, lipid profiles, blood chemistry, and skin thickness in menopausal women. Med J Indones. Published online May 1, 2002:97. doi:10.13181/mji.v11i2.56
19. Espósito ACC, Cassiano DP, Da Silva CN, et al. Update on Melasma—Part I: Pathogenesis. Dermatol Ther (Heidelb). 2022;12(9):1967-1988. doi:10.1007/s13555-022-00779-x
20. Basha M, Azmy R, Farag M. A study on the effect of estrogen, progesterone, and their cutaneous receptors in the pathogenesis of melisma. Menoufia Med J. 2016;29(2):389. doi:10.4103/1110-2098.192411
21. Gayatri M. Determinants of Contraceptive Use in Rural Poor Areas: Evidence from Indonesia. ijph. 2023;18(1):34-46. doi:10.20473/ijph.v18i1.2023.34-46
22. Murniastuti DS, Etnawati K, Pudjiati SR. The correlation between severity of melasma with facial wrinkles in Yogyakarta, Indonesia. Dermatol Reports. 2020;12(2). doi:10.4081/dr.2020.8390
23. Fardha Nadya Yunitha. Derajat Keparahan Melasma Dikaitkan Dengan Tingkat Harga Diri pada Pasien Di Klinik The Alfein. Disertasi. Published online 2021. UIN Syarif Hidayatullah Jakarta.
24. Putri IN, Putra AP, Juniano N, et al. The Effect of Sunscreen Use on The Incidence of Melasma in Police Officers: Meta-Analysis and Systemic Review. IIMJ. 2024;6(2):12-24. doi:10.33086/iimj.v6i2.6257
25. Azzahra CN, Widyawati W, Afriliana L, Dewantiningrum J. Melasma Show Up in Contraceptive Pills Acceptors. DMJ. 2021;10(1):74-77. doi:10.14710/dmj.v10i1.29436
26. Ibrahim SA, Kang BY, Schlessinger DI, et al. Protocol for development of a core outcome set for clinical trials in melasma. BMJ Open. 2022;12(2):e046953. doi:10.1136/bmjopen-2020-046953
Authors
Susila, I., Ningsih, E. S., Muthoharoh, H., & Ummah, K. (2026). Melasma and prolonged oral contraceptive use: a community-based retrospective cohort study. JURNAL RISET KESEHATAN POLTEKKES DEPKES BANDUNG, 18(1), 234–242. https://doi.org/10.34011/juriskesbdg.v18i1.3140
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