Dermatology 2026

Melasma is increasingly understood as a disorder of the epidermal-dermal microenvironment rather than isolated melanocyte hyperactivity. Basement membrane disruption, vascular changes, mast-cell activity, senescent fibroblasts, oxidative stress, and paracrine mediators contribute to persistence and relapse. We evaluated an intradermal formulation of high-molecular-weight hyaluronic acid (1.1%) and sodium succinate (1.6%) as microenvironment-directed monotherapy. Four women aged 26-44 years with facial melasma (baseline MASI 1.514.8) were enrolled in a prospective pilot case series. Each received 2 mL intradermally using a micropapular technique in three sessions at 2-week intervals. Assessment included serial standardized photography, MASI, and computer-assisted imaging under cross-polarized, standard, and brown-light modes. Preliminary follow-up demonstrated a decrease in MASI, driven mainly by reduced pigment homogeneity, together with reduced erythema on cross-polarized imaging. The most visible response was observed in participants with concomitant Glogau II-III photodamage. One participant had substantial ultraviolet exposure and tanning during treatment, representing an important confounder. No comparative arm was included. These preliminary observations support the hypothesis that targeting the melanocyte microenvironment, rather than melanogenesis alone, may have clinical relevance in melasma. Larger controlled studies with objective pigmentation, vascular, and barrier endpoints, longer follow-up, and histologic or molecular assessment are required to determine efficacy and mechanism.

Alina Chenkova, MD, is a dermatologist and aesthetic physician and Chief Physician at Aloe Vera Clinic in Batumi, Georgia. Her work focuses on evidence-based dermatology and pathophysiology-driven aesthetic medicine, with particular interests in melasma, acne, rosacea, skin aging, and regenerative approaches. She is the author of Skin for Life, creator of the BeautyC.O.D. clinical framework, an EADV member, international medical trainer, and recipient of the ICCE Swift Award. Her current research addresses the melasma microenvironment, collagen disorganization, and objective diagnostic methods in aesthetic dermatology