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To decipher the role of sex hormones in melasma, this viewpoint reviews the effects of sex hormones on cutaneous cells cultured in monolayers, in coculture, in 3D models and explants in the presence or the absence of <jats:styled-content style=\"fixed-case\">UV<\/jats:styled-content>. The data show that sex steroid hormones, especially oestrogen, can modulate in vitro pigmentation by stimulating melanocytes and keratinocyte pro\u2010pigmentary factors, but not via fibroblast or mast cell activation. In vitro data suggest that oestrogen acts on endothelial cell count, which may in turn increase endothelin\u20101 concentrations. However, data on explants revealed that sex steroid even at doses observed during pregnancy cannot induce melanogenesis alone nor melanosome transfer but that it acts in synergy with <jats:styled-content style=\"fixed-case\">UVB<\/jats:styled-content>. In conclusion, we hypothesize that in predisposed persons, sex steroid hormones initiate hyperpigmentation in melasma by amplifying the effects of <jats:styled-content style=\"fixed-case\">UV<\/jats:styled-content> on melanogenesis via direct effects on melanocytes or indirect effects via keratinocytes and on the transfer of melanosomes. They also help to sustain hyperpigmentation by increasing the number of blood vessels and, in turn, the level of endothelin\u20101.<\/jats:p>","DOI":"10.1111\/exd.13915","type":"journal-article","created":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T23:57:57Z","timestamp":1552953477000},"page":"709-718","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["How hormones may modulate human skin pigmentation in melasma: An in vitro perspective"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-5684","authenticated-orcid":false,"given":"Muriel","family":"Cario","sequence":"first","affiliation":[{"name":"Inserm 1035  Bordeaux France"},{"name":"Univ. 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