Melasma: The Daily PANCE Blueprint
A 28-year-old female with an unremarkable medical history presents to the clinic during the summer complaining of some persistent "dark spots” on her face. On physical exam, you see irregular light-brown patches on the lateral cheeks and nasolabial folds. Which of the following is the first line initial treatment for the most likely diagnosis?
A. Hydroxychloroquine
B. Systemic steroids
C. Topical hydroquinone 4% cream
D. Oral tranexamic acid
E. Chemical peels
Answer and topic summary
The answer is C. Topical 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., the 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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Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
