Melasma Treatment Follow-Up in Katy & Houston, TX: Case Report of Persistent Facial Hyperpigmentation
By: Dr. Caroline Vaughn
Melasma can be one of the most frustrating pigment conditions to treat due to its chronic, relapsing nature. At Village Dermatology, we take a multimodal and maintenance-based approach to help patients achieve long-term improvement. This case highlights a melasma follow-up visit in a 50-year-old male treated in Katy and Houston, Texas.
Patient Presentation
A 50-year-old male returned for a three-month follow-up for melasma affecting the left central malar cheek.
At his previous visit (August 27, 2025), he was prescribed:
Tretinoin 0.025% cream (pea-sized amount, 2–3 nights weekly increasing to nightly as tolerated)
Oral tranexamic acid 650 mg, ½ tablet twice daily
Despite adherence to treatment, the patient reported minimal improvement. He noted that a prior compounded hydroquinone formulation had provided slightly better results.
Clinical Examination
A focused facial examination was performed using dermoscopy.
Findings included:
Ill-defined hyperpigmented patches
Periorbital/malar distribution
Located primarily on the left central malar cheek
Overall, the melasma appeared relatively controlled but with persistent residual pigmentation.
Diagnosis
Melasma
Chronic hyperpigmentation disorder affecting sun-exposed facial areas.
Treatment Plan
After extensive discussion, the following plan was agreed upon:
Restart Compounded Hydroquinone
Resume a 3-month course
Emphasized that hydroquinone is not intended for long-term continuous use
Reviewed risks including rare pseudoochronosis
Continue Tretinoin 0.025%
Safe for long-term maintenance therapy
Apply pea-sized amount nightly as tolerated
Procedural Options Discussed
Melanage® peel
Superficial chemical peels
Other pigment-targeting treatments
The patient may consider a Melanage peel in the future.
Importance of Sun Protection
Strict daily photoprotection was emphasized as the foundation of melasma management:
Reapplication during sun exposure
Sun avoidance when possible
Protective hats and clothing
Without consistent sun protection, melasma recurrence is common.
Patient Counseling & Education
Expectations
Melasma is chronic and often triggered by:
Sun exposure
Hormonal changes
Heat
Maintenance therapy is typically required
Retinoid Counseling
Apply at bedtime
Wait 30 minutes after washing face
Use moisturizer if dryness occurs
When to Contact the Office
If melasma worsens
If medication side effects develop
If pigment changes appear concerning
Clinical photos were obtained for monitoring progress. The patient will message the office if he needs a refill on compounded hydroquinone.
Follow-Up
Follow up in 4 months for reassessment
Long-term maintenance visit annually
Advanced Melasma Treatment in Katy & Houston
At Village Dermatology, we provide comprehensive melasma management including:
Topical retinoids
Hydroquinone therapy
Oral tranexamic acid
Chemical peels
Laser treatments
If you are struggling with facial hyperpigmentation or dark patches, our dermatology team in Katy and Houston, Texas can help create a customized treatment plan.
