Treating Facial Melasma with Prescription Therapy | Village Dermatology Katy & Houston, TX

Jun 13

By: Dr. Ashley Baldree

Introduction

Melasma is a common skin condition that causes brown to gray-brown patches on the face, especially among women. At Village Dermatology, we understand that skin discoloration can be frustrating, especially when it's mistaken for other conditions like vitiligo. In this case, we helped a 42-year-old woman who had been struggling with light and dark patches on her face for over a year.

Case Summary: Facial Discoloration Concerns

Patient: 42-year-old female
Primary Concern: Discoloration on the face
Duration: 1 year
Distribution: Right cheek, left cheek, and forehead
Medical History: Family history of vitiligo (aunt); patient is a smoker

Clinical Findings & Diagnosis

We performed a comprehensive facial exam, including a Wood’s lamp test (used to differentiate pigmentation disorders). The lighter areas appeared to reflect the patient's natural baseline skin tone, while the darker, ill-defined hyperpigmented patches were consistent with melasma—not vitiligo.

Diagnosis: Melasma (L81.1)
Distribution: Periorbital and malar regions (under eyes and cheeks)

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Treatment Plan for Melasma

Melasma can be challenging to treat, especially with long-term sun exposure or hormonal triggers. We created a treatment plan combining prescription therapy and sun protection:

🧴 1. Tri-Luma Cream (Hydroquinone + Tretinoin + Fluocinolone)

Application: At bedtime for 3 months, then paused for 1 month
Purpose: Targets pigmentation at the cellular level
Counseling: Discussed risk of irritation, dryness, and rare side effect of pseudoochronosis (bluish skin discoloration)

💊 2. Oral Tranexamic Acid (650mg)

Dose: Half a tablet twice daily
Purpose: Reduces melanin production via hormonal pathways
Counseling: Avoid smoking and hormonal contraceptives; discussed small risk of blood clots

☀️ 3. Daily Tinted Broad-Spectrum Sunscreen (SPF 30+)

Essential for preventing recurrence and protecting sensitive skin during treatment

Lifestyle Guidance & Expectations

Triggers of Melasma: Sun exposure, heat, pregnancy, and birth control pills
Skin Care Recommendations: Non-irritating cleansers, sun avoidance, and daily SPF use
Patient Education: Counseling provided on medication risks, expectations for gradual improvement, and the importance of treatment breaks

Photos were taken to monitor progress, and the patient will return in 3 months for a skin check and evaluation of treatment efficacy.

Why This Matters in Katy & Houston, TX

Sun exposure in Houston and Katy's warm climate can worsen melasma, especially for individuals with medium-to-darker skin tones. Our team at Village Dermatology provides evidence-based treatments with personalized education to help patients manage pigmentation safely and effectively.

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