Clinical Pearls for Melasma and Other Hyperpigmentation Disorders, With Andrew Alexis, MD, MPH

In this segment of his 2025 Fall Clinical Dermatology Conference interview on-site in Las Vegas, Andrew Alexis, MD, MPH, interviewed with HCPLive regarding his talk ‘Melasma and Other Hyperpigmentation Disorders.’1

Alexis is known for his work as both a professor of Clinical Dermatology and as vice-chair for Diversity and Inclusion at Weill Cornell Medicine. He spoke in this segment on the topic of melasma and hyperpigmentation in general, disorders particularly affecting patients with melanin-rich skin.

“In fact, so many of our patients might have an inflammatory disorder like acne or atopic dermatitis, psoriasis, and others, and be just as concerned about the hyperpigmentation as they are by the primary disorder that caused it,” Alexis explained. “So having tools to be able to address hyperpigmentation for our patients is extremely valuable and leads to better patient outcomes.”

Alexis highlighted some of the most notable takeaways from his session, noting the value of topicals and photoprotection.

“Among our topical therapies, photo protection is step one,” Alexis said. “When it comes to photo protection, we are protecting against both UV radiation and visible light, to the extent that we can. We can do that with tinted sunscreens containing iron oxide. We can do that with some sunscreens that contain free radical quenchers and potent antioxidants. We can even add an oral agent with potent antioxidant effects, such as oral polypodium leucotomos extract.”

Then, Alexis noted, treatment of the hyperpigmentation can be done a variety of ways. He added that clinicians have a growing list of topical therapies available for hyperpigmentation disorders.

“We have our traditional prescription agents, most notably hydroquinone, which inhibits tyrosinase, but we have a host of non-hydroquinone agents that we can consider for longer-term management,” Alexis explained. “Hydroquinone is suitable for three to six months of therapy, depending on the concentration used, but it's not suitable for long-term continuous therapy because of the risk of exogenous ochronosis. So what are our alternatives? We have topical azelaic acid. We have a number of novel ingredients that have recently come to the market, such as Thiamidol, Cysteamine, and Melasyl.”

Later, Alexis also highlighted the growing awareness about the need to focus on unmet needs related to pigmentary disorders in patients with skin of color. These unmet needs can particularly be seen in acquired dermal macular hyperpigmentation (ADMH), which can require immuno-regulatory and pigment-reducing treatments, including low-dose oral isotretinoin.

To learn more about the topics highlighted in Alexis’s session, view his interview posted above.

View our coverage of the latest news from the Fall Clinical Dermatology meeting for further information on recent topics in dermatology.

Alexis has previously reported grants from Leo, Amgen, Galderma, Arcutis, Dermavant, AbbVie, Castle, and Incyte; advisory board/consulting fees from Leo, Galderma, Pfizer, Sanofi-Regeneron, Genzyme, Dermavant, Beiersdorf, Ortho, L’Oréal, Bristol Myers Squibb, Bausch Health, UCB, Arcutis, Janssen, Allergan, Almirall, AbbVie, Amgen, VisualDx, Eli Lilly, Swiss American, Cutera, Cara, EPI, Incyte, Castle, Apogee, Canfield, Alphyn, Avita Medical, Genentech, and Boehringer Ingelheim; speaker fees from Regeneron, Sanofi-Genzyme, Bristol Myers Squibb, L’Oréal, Janssen, J&J, and Aerolase; royalties from Springer, Wiley-Blackwell, Wolters Kluwer Health, and Elsevier.

References

1. Alexis A. Melasma and Other Hyperpigmentation Disorders. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.