Innovations in Hyperpigmentation: Our Conversation with a Top Physician-Scientist

In honor of Melasma and Hyperpigmentation Awareness Month, William Ju, MD, FAAD, President of Advancing Innovation in Dermatology, Inc. sat down with Christina Weng to discuss the latest insights and innovations on melasma and hyperpigmentation.

William Ju, MD, FAAD: What persistent problems do you see scientists and dermatologists struggling to solve in the field of hyperpigmentation and melasma? How can the collaboration between researchers, dermatologists, and industry leaders be improved to tackle these persistent issues?

Christina Weng, MD, FAAD: While there have been significant advances in our understanding of the mechanistic pathways driving hyperpigmentation, in some ways the therapeutic options in the clinic have not yet caught up with the science. More than ever, we need collaboration across basic scientists, dermatologists, and industry. We also need physician-scientists and physician-entrepreneurs in dermatology and aesthetics who are able to traverse these worlds and bring clinical experience to bench research, scientific rigor to clinical practice, and operational expertise to academia.

That being said, there’s been concrete evolution in how we tackle melasma in the clinic. Traditionally patients have been counseled on sun avoidance and protection, this is the bare minimum and should be thought as the backbone of any melasma therapy, rather than a cure. We are better understanding how visible light can aggravate melasma – particularly within the high energy visible light and long wave UVA spectrum. Most sunscreens, even those with broad spectrum protection, are not sufficient to protect against these wavelengths, and we encourage melasma patients to look for SPF products containing iron oxide, a physical blocker, for the best protection.

As of now there is no single curative therapy, and there remains a high unmet need for an effective treatment that works across all skin types. Additionally, as melasma often flares with pregnancy, I’d love to see a therapy that is safe to use during pregnancy and while breastfeeding.

There’s been a shift towards combination treatment for hyperpigmentation and melasma. For example, a patient may receive fractionated laser treatment followed immediately by a topical application of vitamin C which enhances penetration of the active ingredient in addition to the direct effects of the laser. The patient may also be supplemented before and after in-office procedures with at-home applications of topical ingredients such as kojic acid, hydroquinone, vitamin C, and retinoids. Additionally, there are oral therapies such as tranexamic acid, though not suitable for all patients.

William Ju, MD, FAAD: How has the dedication and innovation of your colleagues influenced the progress being made in hyperpigmentation and melasma research and treatment?

Christina Weng, MD, FAAD: There is a lot of work in melasma and other pigmentary conditions being done at Massachusetts General Hospital / Harvard Medical School where I practice. This spans basic science research on tanning pathways (including UV-independent drivers of pigmentation) at the Cutaneous Biology Research Center as well as clinical research and patient care within our dermatology clinics. Dr. Mathew Avram, who treats many patients with melasma in his role as Director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, notes that while peels and lasers can provide improvement in many cases, appropriate treatment parameters are critical as worsening of hyperpigmentation is a possible side effect. This risk is even more heighted in patients with more pigment in their skin, as well as those who have more sun exposure. There is no one-size-fits-all treatment at this time, and a multi-faceted approach is key as currently available therapies are too often still partially effective.

About Christina Weng, MD, FAAD: Dr. Weng is a board-certified dermatologist at Massachusetts General Hospital and faculty at Harvard Medical School. Her peer-reviewed and published research at the Cutaneous Biology Research Center focused on skin pigmentation. A strategic biotechnology executive, physician-scientist, and entrepreneur with an impressive portfolio, she currently serves as Chief Medical Officer at Pelage Pharma. Before that she was at Kira Pharmaceuticals and Mymiel. Christina’s expertise extends from research and development to innovative corporate storytelling. She brings a wealth of knowledge and experience to AID, where she is an esteemed member of our conference advisory board.