Bilateral areolar hyperpigmentation following transdermal application of compounded hormone replacement therapy.

A 61 year-old post-menopausal Caucasian woman presented to the pharmacy to re-initiate hormone therapy after having discontinued treatment for three years. She had discontinued previous hormone therapy due to severe hyperpigmentation of both nipples and areola. She stated that her nipples and areola had turned black, as if they had been burned. This reaction seemed unique, and we felt that it warranted further investigation.