Managing Longstanding Melasma in a 50-Year-Old Female — Village Dermatology Katy & Houston, Texas
Melasma is one of the most common causes of facial discoloration in adult women and a frequent concern among dermatology patients across Katy, Texas and Houston, Texas. This case report highlights the evaluation and management of a 50-year-old female presenting with chronic cheek discoloration consistent with melasma.
Chief Complaint
The patient presented with asymptomatic facial discoloration, primarily on the:
Right central malar cheek
Left central malar cheek
She reported having this pigmentation for several years without any current treatment.
Clinical Examination
A focused facial examination was performed, including:
Forehead
Cheeks
Nose
The patient appeared well-nourished, alert, and in no acute distress.
Hyperpigmented, ill-defined patches were noted in a malar and periorbital distribution, characteristic of melasma.
Diagnosis
Melasma
Melasma presents as patchy facial hyperpigmentation and is more common in women, often triggered by:
Hormonal changes
Birth control or pregnancy
Sun exposure
Heat and inflammation
The patient had a history of using compounded hydroquinone but experienced worsening pigmentation when tapering the strength.
Treatment Discussion
A comprehensive review of treatment options was provided, including:
1. Topical Treatments
Tretinoin cream (refilled today)
Enhances skin turnover and improves discoloration
Bleaching agents (HQ)
Effective but risk of pseudoochronosis with excessive or prolonged use
2. Oral Therapy
Tranexamic acid
Reduces melanocyte activity
Helpful for stubborn or recurrent melasma
Risks discussed: small risk of blood clots, gastrointestinal upset
Patient confirmed no personal or family history of clotting disorders
3. Procedural Options
Non-ablative laser therapy (Fraxel)
Pricing for the chemical peel was provided.
4. Sun Protection
A critical component of treatment:
Tinted mineral sunscreen preferred for iron oxides, which protect against visible light
Strict sun avoidance during peak UV hours
Plan
After extensive discussion, the patient elected to begin combination therapy:
Medications Prescribed:
Tranexamic Acid 650 mg
Take ½ tablet PO BID
Tretinoin 0.025% cream
Apply a pea-sized amount 2–3 nights/week, increasing as tolerated
Counseling Provided:
Expected gradual improvement over months
Importance of consistency with sun protection
Instruction to contact the office if pigmentation worsens or if medication side effects occur
Follow-Up:
A 2-month targeted follow-up is scheduled to evaluate progress and consider peels or laser treatments.
Why Melasma Requires Expert Dermatologic Care
At Village Dermatology in Katy and Houston, we frequently help patients manage chronic melasma. Because this condition can worsen with heat, sun, inappropriate skincare products, or certain medications, professional guidance ensures safe and effective treatment.
Our approach combines:
Personalized assessment
Stepwise treatment plans
Evidence-based procedures
Long-term maintenance strategies
