Dermatologists should consider assessing melasma patients for increased vascularity and “include anti-vascular treatments, including tranexamic acid and laser and light therapies, to improve outcomes among melasma patients whose lesions have a vascular component,” reported

The commentary follows a systematic review of 34 published research articles by the Department of Dermatology at State University of New York and published in the journal Dermatologic Surgery where the authors found strong evidence for what they called “the important and under-reported vascular component of melasma” and summed up: “Methods of evaluation of the vascular component of melasma are relatively accessible and may positively impact the patient’s clinical course, particularly for recalcitrant melasma cases.”

While conventional melasma treatment regimens have focused on sun protection and lightening agents, and genomics, hormonal imbalance and UV exposure “are widely accepted contributors to melasma pathogenesis”, the researchers noted “evidence is building that suggests there may be an important vascular component to melasma pathogenesis”.

They emphasised: “Emerging evidence indicates melasma pathogenesis may involve aberrant angiogenesis and vasodilation of dermal blood vessels, rather than solely increased melanogenesis resulting in hyper-pigmentation.”

The authors hypothesise that increased vasculature, vasodilation and inflammation “result in dermal capillaries in melasma lesions becoming increasingly permeable. The capillaries leak red blood cells, which contributes to hyper-pigmentation that might come from solar light or light from electronic devices”.

Sources: Dermatological Surgery and

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