Hyperpigmentation Prevention and Treatment: Melasma, PIH, and Oral Tranexamic Acid

Dr Andrew Alexis (Weill Cornell Medicine) joins hosts Dr Alice Gottlieb and Dr Joseph Merola to break down a practical, stage-by-stage approach to hyperpigmentation in skin of color.

Topics covered: preventing post-inflammatory hyperpigmentation (PIH) by treating the underlying inflammatory disorder early, photoprotection counseling for patients with darker skin types, visible-light protection with tinted (iron oxide) sunscreens, and dosing and timing for oral polypodium leucotomas. Dr Alexis walks through his treatment algorithm for melasma and PIH, including hydroquinone dosing and duration, the triple combination formula (hydroquinone, tretinoin, and a topical steroid), when to add procedures like non-ablative fractional lasers, picosecond lasers, or chemical peels, and how he uses a Wood's lamp to assess pigment depth and set patient expectations.

The conversation also covers oral tranexamic acid for melasma and PIH, including dosing, duration, and how to screen out patients with clot risk, plus a look at diagnoses that mimic hyperpigmentation and can derail treatment, including lichen planus pigmentosus, acquired dermal macular hyperpigmentation, discoid lupus, morphea, and medication-induced hyperpigmentation from drugs like diltiazem.

Saturday Morning Live is a free virtual dermatology education series from Masterclasses in Dermatology, co-chaired by Dr Alice Gottlieb and Dr Joseph Merola. Sessions run a few hours on a Saturday, no travel required.

Thank you for listening.