Panelists discuss how melasma is a chronic disease caused by the interplay of hormones, sunlight, heat, and genetic predisposition, emphasizing that prevention through comprehensive sun protection including daily sunscreen use (particularly tinted mineral formulations), avoiding peak sun hours, wearing protective clothing, and considering oral supplements is essential for managing this condition that requires lifelong treatment rather than a cure.
Panelists discuss how melasma diagnosis requires identifying specific location patterns, absence of scale, avoidance of eyelid areas, and using Wood lamp examination to differentiate between superficial and deep melasma while distinguishing it from other pigmentary conditions such as postinflammatory hyperpigmentation and solar lentigines.
Panelists discuss how treatment selection for melasma should begin with topical regimens including lightening agents, retinoids, and sun protection before considering procedures, emphasizing patient adherence and the appropriate use of hydroquinone and triple combination therapies as gold standard treatments despite some tolerability concerns.
Panelists discuss how hydroquinone’s safety concerns including ochronosis and irritation necessitate the use of alternative tyrosinase inhibitors such as thiamidol, cysteamine, kojic acid, and lotus sprout extract, which offer better tolerability and can provide an overall skin evening and glow that patients desire.
Panelists discuss how nonhydroquinone agents, such as thiamidol, demonstrate excellent tolerability profiles in data from head-to-head studies and how combination therapies including chemical peels, picosecond lasers, microneedling with transdermal delivery, and oral tranexamic acid can be used as adjunctive treatments for stubborn melasma cases that plateau with topical therapy alone.
Panelists discuss how thiamidol has shown real-world success in treating stippled postinflammatory hyperpigmentation (PIH) from acne picking when applied 4 times daily alongside retinoids and chemical peels, with the key being proper product layering and selecting adherent patients who can manage multiple daily applications.
Panelists discuss how chemical peel selection must consider Fitzpatrick skin type with superficial peels safe for all patients while medium-depth peels require careful application in darker skin, and how treatment adherence is affected by multiple factors including application frequency, cost burden, insurance coverage limitations, and the need to manage patient expectations while accounting for concurrent use of social media–influenced products.
Panelists discuss how postinflammatory hyperpigmentation (PIH) from acne requires simultaneous treatment of both the underlying acne and the resulting pigmentation using retinoids as first-line therapy, salicylic acid for exfoliation, and newer cosmeceuticals that can be tolerated even during isotretinoin therapy, emphasizing that treating pigmentation alone without addressing active acne is ineffective.
Panelists discuss how long-term management of melasma and postinflammatory hyperpigmentation requires lifelong maintenance regimens including retinoids for all patients, consistent sunscreen use with reapplication, proper diagnosis through biopsy when treatments fail to respond, and recognition that patients may have multiple concurrent conditions requiring different treatment approaches.
