A groundbreaking center dedicated entirely to melasma treatment and research is now open, with a virtual global support group for people with melasma about to launch. 

To help transform care for patients with melasma, in October, Pearl E. Grimes, MD, a leading authority on vitiligo and pigmentary disorders, announced the launch of P’erl: The Melasma Research & Treatment Institute, a center devoted to pioneering new research into melasma treatment. “This is a vision about bringing awareness and research to the forefront of dermatology for a disease that’s gone neglected for way too long,” said Grimes, the director and founder of the institute, who is also director of the Vitiligo and Pigmentation Institute of Southern California and clinical professor of dermatology at the University of California, Los Angeles.

As stated on the P’erl homepage, the mission is to “provide expert clinical care for individuals with melasma while advancing research to best define its causes, contributing factors, and foster the development of novel therapies for optimal management and enduring remission.” The end goal? A cure.

“The focus is to reassess where we stand regarding the pathogenesis and contributing factors for melasma,” Grimes told Medscape Dermatology. “Hopefully, by taking a new deep dive, it will allow us to view the disease through a new lens.”

Grimes said that while major advances have recently been made in vitiligo, she believes that when treating patients with melasma, science has fallen short. Many affected by melasma feel like outsiders, she said, burdened by shame over how it alters their appearance.

“The burden of melasma, those brown patches on normal skin, is enormous, because most women want clear skin where they don’t feel they need to camouflage it,” she said.

She noted that relapse rates are all too common for those living with the disease. “You can have a patient clear, and they go out and get a little bit of sunlight, they flare; they go on a sunny vacation, they flare,” Grimes said. “They have to pick and choose how they enjoy recreational activities with their families. It’s a source of profound frustration.”

Seemal Desai, MD, a member of the institute’s advisory board, who practices dermatology in Plano, Texas, and is the past president of the American Academy of Dermatology, characterized the new center as “a landmark opportunity to bring melasma to the forefront of understanding that this is simply not a cosmetic condition.” 

In an interview, he added, “This is our way of leading the narrative that melasma should be recognized as a chronic skin disease, just like other diseases in dermatology: psoriasis, alopecia areata, and vitiligo.” In addition, he observed, “We always talk about the fact that melasma is more prevalent in darker racial ethnic groups, but if I look at my patient population, I think melasma has been underdiagnosed in women with skin type 3. No question about it.”

A key feature of the center is the creation of a global virtual support group for people with melasma, set to launch on November 11, which Grimes said will be the first of its kind. A patient with melasma will chair the group. She envisions it as a space where individuals can share their stories, and over time, she hopes that the support group’s advocacy will help inspire the development of new treatments for melasma and help ensure that it is recognized as a disease. Grimes noted that no FDA-approved treatment for melasma has been introduced since the topical fluocinolone, tretinoin, and hydroquinone combination product (Tri-Luma) was approved in 2002.

Other clinical advisors to P’erl include professionals Grimes has collaborated with throughout her career, including Tim McCraw, PhD, CEO of the consulting firm Skin Science Advisors; Jag Bhawan, MD, a Boston-based dermatopathologist; Mona A. Gohara, clinical professor of dermatology at Yale School of Medicine, New Haven, Connecticut; and Murali Duvvuri, PhD, a North Carolina-based pharmaceutical scientist with more than 20 years of experience developing compounds for various indications.

Going forward, Grimes and her colleagues plan to review the full clinical spectrum of melasma, looking for differences across racial and ethnic groups and “examining every possible angle,” she said. “We’ll also revisit and replicate some of the foundational studies that have already been done.” Depending on what they uncover, results could guide them toward alternative treatment approaches or highlight areas that may have been overlooked.

“This is a very complex condition — I call it ‘the capricious one’ — and we know that genetics is a player,” Grimes said. “At least half of patients have someone else in the family with it. And it’s not just one melanocyte spewing out pigment. You’ve got multiple cell types. You’ve got the keratinocytes sending out cytokines that trigger pigment. Fibroblasts, mast cells, and endothelial cells are also involved.”

Grimes emphasized that enhancing the stability and durability of melasma treatments ultimately benefits patients. “It’s about hopefully adding something to the literature that will make a key difference,” she said. “That will give us new insight and [identify] potentially new pathways.”

The P’erl Institute reported not receiving support from external funding sources. Grimes reported serving as a clinical investigator and/or consultant for Galderma; Clinuvel; L’Oréal; Johnson & Johnson; LASEROPTEK; Versicolor Technologies; Merck, DermBiont, Inc.; VYNE Therapeutics; RAPT Therapeutics; Incyte; Pfizer; AbbVie/Allergan; Skinbetter Science; Klotho Skin; Beiersdorf; and Medscape Medical News. She also reported holding stock options in Versicolor Technologies.

Doug Brunk is a San Diego-based medical journalist.