Melasma: The Daily PANCE Blueprint
A 31-year-old female presents with irregular, light-brown patches on her cheeks and forehead that developed gradually over the past few months. She recently started a new oral contraceptive and spends a lot of time outdoors. Which of the following is an appropriate first-line treatment for her condition?
A. Oral tranexamic acid
B. Hydroquinone 4% cream
C. Laser therapy
D. Systemic corticosteroids
E. Referral to plastic surgery
Answer and topic summary
The answer is B. Hydroquinone 4% cream
Melasma is a chronic disorder of hyperpigmentation that typically occurs in women during their reproductive years. It usually affects body areas with high amounts of sun exposure (i.e., face). The reason it occurs is from hyperfunctional melanocytes that create too much melanin in the dermis and epidermis. Risk factors/triggers include genetics, exposure to sunlight, hormones, and zinc deficiency. On exam you may see irregular light-brown to grayish-brown patches. Common patterns of distribution include malar (lateral cheeks), centrofacial (forehead, nose, cheeks, chin), and mandibular (lower jawline). Management includes sun avoidance, sunscreen, hydroquinone 4% cream (first line for mild disease), and triple combination cream (tretinoin, fluocinolone, hydroquinone) for moderate/severe disease. Chemical peels and oral tranexamic acid are other potential therapies. The last line is laser and light therapy.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
