Improving Treatment of Patchy Skin Pigmentation (Melasma)

Laser-assisted delivery of tranexamic acid
By Michael Contreras, MD

Melasma appears as irregular hyperpigmented patches on facial areas, especially around the eyes and mouth, and cheeks.  It is more common in those with darker skin and in those living in high UV exposure areas.  Risk factors for melasma include sun exposure, pregnancy, hormones (birth control or hormone replacement therapy), thyroid disease, and some medications.   This is a common condition seen by the board certified Dermatologists at AboutSkin Dermatology.

Treatment of melasma focuses on both inhibiting the over-production of pigment by the pigment-producing cells (melanocytes) and interfering with the transfer of pigment to the skin cells.  Melasma is known to be very stubborn, and improvement often requires a comprehensive regimen of rigorous sun protection, topical lightening creams, and a series of procedures.   Once lightening has been achieved, a maintenance regimen is critical because recurrence of melasma very common.

Treatment options currently available:

  • Sun avoidance and protection
  • Bleaching creams (with or without hydroquinone)
  • Chemical peels (series of multiple treatments)
  • Laser and light sources (series of multiple treatments)
  • Tranexamic acid
  • Laser assisted drug delivery of tranexamic acid – newest promising technology

Laser assisted drug delivery:  Our skin surface functions as a protective barrier to substances external to our bodies.  While this is useful in preventing absorption of irritating and potentially toxic chemicals, it also limits the absorption and desired effects of topically applied medications.  Laser assisted drug delivery involves laser pretreatment of the skin to help increase the permeability of the skin barrier. This allows for enhanced absorption of topical medications.  Dr. Joel Cohen recently discussed laser assisted drug delivery on ABC Denver Channel 7, see segment below.

Tranexamic acid is drug that has recently emerged as a promising treatment for  melasma.  It has been used topically, orally, injected into lesions, and applied directly after treatment with laser and microneedling.  The use of tranexamic acid for treatment of melasma has not been approved by the FDA, but there are many reports and small studies showing it’s beneficial effects.

At AboutSkin Dermatology with offices in the Denver area (Greenwood Village and Lone Tree) we are happy to offer the newest technology in the treatment of melasma.  Using LaseMD (a thulium fractionated laser) we pretreat the affected skin surface to allow penetration of topically applied tranexamic acid directly to the deeper layers of the epidermis where melasma pigment is located.

A recent study of 68 Korean patients using the LaseMD/tranexamic acid combination proved the efficacy of this approach.  After lasering the skin with LaseMD, three different topicals were applied (tranexamic acid, vitamin C, or vitamin A).  Three treatment sessions were performed at an interval of 2-4 weeks.  Average improvement in melasma scores of all patients was 29%; however, tranexamic acid treated patients showed 44% improvement, outperforming the two other topical treatments. Post-treatment downtime consisted of mild redness and swelling for 1-2 days followed by skin dryness for 2-5 days.

Once melasma has improved, rigorous sun protection, topical lightening products, and regularly spaced chemical peels and/or low energy laser devices will help to maintain results.

AboutSkin Dermatology is dedicated to providing cutting-edge treatments to our patients seeking effective and proficient care of their skin.  Call 303-756-7546 to schedule a consultation with one of our board-certified Dermatology physicians.