Struggling With Melasma? There’s A Pill for That


Rays of sunshine and LA go together like Instagram influencers and Runyon Canyon hikes—you just know you’ll see ‘em if you’re there. And it’s the same sun that produces pesky brown skin patches known as melasma. Triggered by hormones (pregnancy, birth control pills), UV rays, or heat, melasma is super common (up to 33-percent of people might experience it). Under the constant sun and hot lights of Hollywood, it makes sense that it’d be even more widespread among Angelino women. LA beauty insiders look to Dr. Nancy Samolitis, Co-Founder and Medical Director of Facile Dermatology, as their secret weapon when it comes to this issue. Quietly referred to as “The Queen of Melasma,” the derm actually uses an inside-out approach to this potentially chronic problem.

Dr. Samolitis says that the easiest way to not have melasma is to avoid triggers as much as you can—namely by wearing sun protection. But when UV light hits anywhere on your body, she explains, your brain signals your skin to protect itself by making more melanin. That means even if your face is covered by SPF 100 and a shield, if your legs get tan, your melasma can darken too. Prescription brightening products help fade it, but mostly for those with lighter skin, less severe cases, and fresh splotches. Their over-the-counter options take longer to work. In-office treatments like lasers and peels can yield incredibly quick results, but Dr. Samolitis emphasizes the importance of combining treatments, “Otherwise they can be a waste of your money and time or even worsen the problem.” Plus, just because you successfully fade your melasma doesn’t mean it won’t come back.

Now you’re up to speed: melasma is a slippery fellow and the treatments available aren’t all that reliable. Ready to hear Dr. Samolitis’ secret? Taken orally, tranexamic acid is actually really good at fading melasma from the inside out. Similar to Latisse, which was originally used for glaucoma until doctors noticed their patients growing super long lashes, tranexamic acid’s beautifying abilities were discovered by accident. “Traditionally, it’s used to control substantial bleeding for women with heavy periods or sometimes prior to surgery,” she explains. But people who were taking it noticed that their melasma improved, too. After a little poking around, “Oral tranexamic acid was found to block the skin's ability to overproduce melanin through a different mechanism than most of the topical treatments that we have been using for decades,” says Dr. Samolitis. In layman’s terms, melasma increases the number of small blood vessels in the skin, which triggers a pigment increase—when treated with tranexamic acid, those vascular pathways shut down, and pigment is reduced.

Doctors in Asia pioneered the treatment, but tranexamic acid has been used off label by derms in the US for the past several years. It’s safe for people of all skin tones, and on dark complexions, won’t lighten past your natural all-over color—it only targets the excess pigment in your melasma. “There is a very small increased risk of blood clots with this medication, similar to that of birth control pills,” adds Dr. Samolitis. It’s important to have a conversation with your prescribing doctor to ensure you’re a good candidate, and take tranexamic acid under supervision of a derm.

At the end of the day, even if we are SPF-responsible, melasma happens. “Sometimes your melasma will recur simply because it’s summer, you went on vacation, or were too busy having fun to be diligent with your regimen,” says Dr. Samolitis. “But we can always start over again.” Luckily, she just opened doors at a new Melrose Place location—uneven Angelinos, rejoice.

—Zoe Schaeffer