November 7, 2019Skincare


Melasma (also called the “pregnancy mask”) can be stubborn and very frustrating for so many women. To address the questions I’ve been getting about melasma, I shared a series of posts covering this topic, including Melasma 101, 102, and 103.

Now, I’m sharing some brand new information. It’s not very often that we see new meaningful developments when it comes to treating melasma, so I am excited to share these new developments with you guys.

New Studies re: Antihistamine Use and Melasma:

If you have melasma, you might want to consider taking a daily antihistamine, like Claritin or Zyrtec. Why?

New studies are showing that there is an increase in mast cells in melasma.  Mast cells are cells that release histamine and other molecules that make you itchy and red – we usually think about mast cells when we think about allergies, but now we are seeing they play a role in melasma as well!

These mast cells can actually break down a type of collagen, collagen 4, which is found in the basement membrane of our skin. In melasma, the extra mast cells found in the skin release substances that chew away the membrane that separates the top layer of our skin from the bottom layer, called the dermis. When that happens, the pigment in our upper layers can drop down into the deeper layers, and that is NOT a good thing.

If you have melasma, your doctor might have told you that your pigment is DEEP, in the deeper layers of your skin, and that could be a reason why it’s so stubborn and not responding to therapy. So what if we could prevent the mast cells from destroying the basement membrane?  And, what if we could keep that pigment in the upper layers, where it’s easier to treat?

Well, there are ongoing studies looking at just that! They are looking at whether taking a daily oral antihistamine (like Allegra, Zyrtec, Claritin) might actually help with melasma. It’s worth considering if you have a very stubborn case. I will share more on this as the science develops!

Tranexamic Acid and Melasma

Another very new development in treating melasma is called tranexamic acid. It works as part of the clotting cascade, so it is FDA approved for conditions like heavy menstrual bleeding, or to help prevent bleeding in people with hemophilia, say when they’re getting a tooth extracted. In melasma, it works by basically dialing down the inflammation that leads to pigment production in the skin. It’s not FDA approved for melasma, so when it’s used for melasma, it’s considered “off label use.” With that said, we are starting to see very promising studies in connection with treating melasma.

Like any other treatment, this is something to raise with your doctor. This is not meant to be a first line treatment. It’s complimentary to all of the other tools used in melasma like brightening creams, sunscreen, Heliocare, and chemical peels. Also, it’s important to note that people who have a history of blood clots, dvt (deep vein thrombosis), are pregnant or nursing, or on birth control should not be taking prescription strength tranexamic acid by mouth. The topical, OTC form of tranexamic acid is newer (so we have less data at this point) and an option for people who are more comfortable using a topical cream vs an oral prescription drug, or for those who are not candidates for the oral form. Again, something to consider and to discuss with your doctor if you have very stubborn melasma.

Dr. Whitney