Melasma hits and misses

Melasma is chronic and prevalent across the globe. Commonly affecting people with dark skin and women, melasma can mimic other pigmentary disorders of the face. Accurate diagnosis is critical for effective treatment.

“Many doctors make mistakes,” said Amit G. Pandya, MD, a dermatology professor at the University of Texas Southwestern Medical Center in Dallas, at Friday’s session, “What’s New in Melasma?” (F005). “You have to be a detective and ask a lot of questions. If you don’t diagnose and treat it correctly, you can make it worse.”

Characterized by gray-brown patches on the face, it typically covers the center of the forehead, over the eyebrow, the bridge of the nose, chin, upper lip, and stops at the jaw line. Its borders are curved.

It can be psychologically debilitating, affecting a person’s social and recreational quality of life and self-esteem.

“People with melasma don’t even feel like answering the door because they are ashamed of the stains,” said Dr. Pandya. “If you understand melasma and intervene, you can change people’s lives.”


Oral contraceptives (primarily estrogen), pregnancy (often fading postpartum), and hormones are common causes of melasma. UV and visible light — even the light from cell phones and computer screens — can trigger it.


Topical application of hydroquinone is effective in treating the disorder 40% of the time. Triple-combination (TC) cream, comprised of fluocinolone acetonide, hydroquinone, and tretinoin is also effective.

Promising new research suggests that the use of oral tranexamic acid with sunscreen containing iron oxide is highly effective. Eunice Del Rosario, MD, MS, a clinical instructor at the University of Texas Southwestern Medical Center in Dallas, cited a recent study showing it was 49% effective in treating melasma compared to just 18% when using sunscreen alone. This treatment requires taking tranexamic acid twice a day for three months. It showed sustained benefits for three months after stopping and using sunscreen alone.

Discontinuing the birth control pill is recommended for treating melasma caused by estrogen. Data suggests all-natural, plant remedies are not effective. Tranexamic acid injections and microneedling are also effective treatments. However, there is no significant difference between the two methods, Dr. Del Rosario said.

“I treat melasma like diabetes. It has to be treated and then maintained because it’s a chronic disorder,” Dr. Pandya said.

It’s not melasma if …

  • It appears on the lateral forehead.
  • It covers the eyelids.
  • It appears on the tip of the nose or at the nasal openings.
  • It has a straight, symmetrical border.
  • It appears on the ear and ear lobe.


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