Melasma in a typical location.
Melasma in a typical location.
Melasma is a very common darkening of the skin of the face in woman. It presents as symmetric brown patches, particularly on the cheeks and upper lip.
Sun protection is paramount in the treatment of melasma, combined with various topical creams, a pill and/or laser.
Visible light can aggravate melasma and thus a physical block sunscreen, e.g., tinted, containing zinc oxide applied immediately upon awakening and several times per day is recommended
Tri-Luma cream the only FDA-approved topical treatment for the short-term management of moderate to severe melasma of the face. It is applied once daily to the affected areas.
Various pharmacies compound various combinations of hydroquinone, a steroid, tretinoin, Kojic acid, etc. and sell them (by prescription) at a substantially lower price than Tri Luma. Although the separate ingredients may been shown beneficial for melasma in clinical studies, any particular combination may not. Thus, the scientific evidence underpinning their use is not as strong as that with Tri Luma.
Tranexamic acid is a synthetic derivative of the amino acid lysine and is FDA-approved for the treatment of cyclic heavy menstrual bleeding. It is only availabie by prescription and is NOT FDA-approved for melasma. In a double-blind study, oral tranexamic acid 250 mg twice daily after food reduced the melasma severity score by 49% at 3 months compared 18% for placebo. Usual doses are typically 500 to 1500 mg daily in 2 to 3 divided doses. Careful screening for personal and familial risk factors for thromboembolism (DVT, PE, Stroke, MI) should be done before initiation although there is little evidence for any increased risk of thromboembolic events at this dose. Few side effects are seen in clinical use.
Melasma of the cheek in a Hispanic woman.
Who is Dr. White? | Privacy Policy | FAQs | Use of Images | Contact Dr. White