Advancements in Melasma and Pigmentary Disorder Treatments

At Fall Dermatology Week, Susan C.  Taylor, MD, FAAD, highlighted comprehensive strategies for addressing melasma and postinflammatory hyperpigmentation (PIH).

Dr Taylor explained that melasma is characterized by symmetrical hyperpigmented patches commonly affecting the centrofacial, malar, and mandibular regions. PIH, often appearing as tan to blue-gray patches, results from skin inflammation or injury. Both conditions are influenced by UV and visible light exposure, genetic factors, and hormonal changes, leading to overproduction of melanin and its transfer to surrounding keratinocytes.

Next, Dr Taylor emphasized a multimodal treatment approach encompassing camouflage, photoprotection, topical therapies, systemic agents, and procedures:

• Photoprotection: Key to both prevention and treatment, broad-spectrum sunscreens containing iron oxide and antioxidants help shield against UV and visible light, critical in reducing melasma severity.
• Topical treatments: The triple combination cream of hydroquinone (4%), tretinoin (0.05%), and fluocinolone (0.01%) remains the gold standard. Other promising agents include cysteamine and isobutylamido thiazolyl resorcinol, shown to significantly reduce Melasma Area and Severity Index (MASI) scores.
• Oral and systemic agents: Dr Taylor discussed the role of oral tranexamic acid, which demonstrated significant MASI score reductions and low relapse rates in clinical studies.
• Procedures: Chemical peels, laser therapy, and microneedling have shown efficacy, particularly when combined with topical agents like tranexamic acid.

Dr Taylor also highlighted innovative treatments such as laser-assisted drug delivery and the use of combination cosmeceuticals to enhance patient outcomes. Safety, especially with systemic treatments like oral tranexamic acid, must be monitored due to potential negative side effects in predisposed individuals.

In conclusion, Dr Taylor underscored the importance of an individualized, patient-centered approach and integrating various modalities for effective management. Combining therapies, ensuring photoprotection, and addressing patient-specific needs remain paramount for improving outcomes in melasma and PIH treatment.

Reference

Taylor SC. Management approaches to melasma and pigmentary disorders. Presented at: Dermatology Week; November 13–16, 2024; Virtual.