Pigmentary Dermatology

Melasma: Hormonal Hyperpigmentation, Estrogen Receptors, Tranexamic Acid & Strict UV Blocking

Author: Mallikarjun R (Founder) & Medicus Labs Medical Team • Review: 12 min read • ✓ Peer-Referenced

1. Pathogenesis of Melanocyte Hyperactivity

Melasma is an acquired hypermelanosis appearing as symmetrical brownish macules across cheeks, forehead, and upper lip. Driven by elevated estrogen/progesterone receptor sensitivity, UV radiation, and visible high-energy visible (HEV) blue light stimulating stem cell factor (SCF) and microphthalmia-associated transcription factor (MITF).

2. Multimodal Management

Kligman's Modified Triple Combination (Hydroquinone 4%, Tretinoin 0.05%, Fluocinolone 0.01%), oral low-dose Tranexamic Acid (250mg BID), and tinted mineral sunscreen containing Iron Oxides to block visible blue light wavelengths.