I use many of the best cutting edge lasers and light devices in my office every day. However, I am the first person to talk my melasma patients out of using these devices, and opting for less expensive options instead. This blog focuses on why! 

If you have melasma, when you first get a laser or light based treatment, you might see the brown patches turn into a coffee ground material, and then slough off. At first, the results look great! However, the next time you go in the sun, you might notice your melasma comes back with a vengeance. I can’t tell you how many patients have come to me in tears after getting a series of laser or IPL (intense pulsed light) treatments at a spa, and realizing that they spent thousands of dollars only to find that their melasma is worse than it ever was.  

Here’s why that happens. We know that melanocytes, the pigment producing cells, are exquisitely sensitive to both heat and light. Consequently, it seems as though most laser and light devices, even used at very low/gentle settings, prime or sensitize the melanocytes. The next time these cells are exposed to sunlight or heat, they work overtime to pump out more pigment. As a dermatologist, on behalf of my patients, I’d rather be safe than sorry. Although every melasma patient would love a quick fix, and laser before and after photos can provide that WOW they are looking for, I strongly urge you to see a provider who takes a more conservative (and often less expensive) route.  

Now if you have sun damage, and your brown spots are lentigos, or sun spots, and NOT melasma, that’s a whole different story! Bring on the lasers and lights! In those cases, I absolutely love using lasers like the Fraxel laser to brighten dark spots from the sun. So, the very first and more important step is to make sure the person deciding on your treatment plan has a very good eye and knows how to diagnose disorders of pigmentation.

I’m sharing so much on melasma right here for you guys and I love the questions you have been asking. Check out my latest posts on my favorite skincare ingredients and products to address melasma and my thoughts on the safety of hydroquinone, a topical treatment often used to treat melasma.

Dr. Whitney

I’ve been getting so many questions about which skincare ingredients are most effective when dealing with melasma, or the type of hyperpigmentation known as the “pregnancy mask.” 

Overall, the strategic combination of complementary ingredients to target different aspects of melasma is, in my opinion, the best approach. Here’s why: some ingredients slow down pigment production, while others stop the transfer of pigment from the melanin producing cells to the other cells in the skin. Other ingredients help exfoliate away the uppermost layers of pigment-stained skin, and others act as antioxidants, neutralizing the free radicals and oxidative stress that makes melasma worse. So, combinations are going to be more effective than single modalities.

But, it’s a delicate balance because we don’t want to overdo it with potentially irritating ingredients. If you cause too much irritation in the skin, this can make melasma worse. 

In this post, I’ll cover both products you can get online or in stores, and ingredients that come in prescription strength, through your doctor. I’ve put together a list of the ingredients I find most effective in addressing melasma, and of course, I’ve added products in each category that I love to use:

Glycolic acid and/or lactic acid: 

While in office peels are going to get you more dramatic results more quickly, you can absolutely see improvements using at home peels if you use them right! 

First, look for ingredients like glycolic acid and lactic acid. If you have oily skin, you might enjoy a peel with salicylic acid, but that can be drying in more sensitive, dry skin types.

The peels you purchase online or over the counter, that are meant for at home use, tend to be much weaker than in office peels. However, you can still run into trouble. At home peels contain many of the same ingredients as in-office peels, so they do come with a risk of burn or skin irritation if used improperly.

Despite what the instructions say, the first time you use one of these at home peels, consider leaving it on for 5 minutes and then rinsing off, and immediately applying a moisturizer – this is the recommendation I make to my patients. This short exposure is a “test run” for your skin to see how you tolerate that peel. Another good rule of thumb is that tingling is ok, but stinging/burning is NOT ok.  If you feel anything more than a tingle, then wash it off immediately and apply a nourishing moisturizer. Burning does NOT mean it’s working- it means it’s triggering too much inflammation in your skin and that can make your melanocytes react by pumping out MORE pigment.  

If your skin feels healthy and you don’t experience any stinging/burning or red blotches in the days following the first peel trial, then you can consider leaving the product on the skin either for 10 minutes, or even overnight, depending on the strength of the product and how sensitive your skin tends to be. The goal is to try to work your way up to using one of these products twice a week at night, with each application spaced 3-4 nights apart.  

Some of my favorite at home peels are:

Moon Juice Acid Potion Resurfacing Exfoliator: (glycolic, lactic and salicylic acid)

Skin Fix Correct+ Dark Spot Corrector: (glycolic acid and lactic acid) 

Herbivore Botanicals Prism 12% Exfoliating Serum: (lactic, glycolic, and malic acids)

Vit C and other antioxidants (turmeric, Vitamin E, honey)

Cover FX Brightening Booster Drops (these drops have an oil soluble derivative of vitamin C called Ascorbyl Tetraisopalmitate.  It’s one of the most stable forms of vitamin C and stability is critical for vitamin C because it is prone to oxidation)  

Skinceuticals CE Ferulic with 15% L-ascorbic acid. (Strong science behind this one, but note that it is expensive)

Bakuchiol (a retinol alternative)

Check out my full blog post on this topic HERE.

Other topical ingredients to consider: azeleic acid, kojic acid, niacinamide, licorice root extract, mulberry extract and tranexamic acid, arbutin and soy. Licorice root seems to be more soothing, while niacinamide can cause irritation in some people. Topical tranexamic acid can sometimes help, but can also cause some irritation. Topical use is much less effective than when I prescribe tranexamic acid orally (more on this immediately below).

Turning to Prescription strength topical ingredients to address melasma:

In my office, I’ll often compound or blend my own prescription strength ingredients for my melasma patients.  Oftentimes, these products combine tretinoin or tazorac (forms of prescription strength vit A) with hydroquinone. Hydroquinone is a controversial ingredient with some very real side effects, so I strongly discourage anyone from using this ingredient if they are not under the direct supervision of a dermatologist. I have an entire post on the safety of hydroquinone here.  I talk about the risks and benefits of these treatments with my patients, and customize my approach for each patient based on their pigment pattern, medical history, budget and comfort level.

For info on how to address your melasma from the inside out through diet and supplements, check back soon!

Dr. Whitney

 

Melasma, and hyperpigmentation in general, is one of the most common reasons people schedule an appointment with a dermatologist. Below, I’ll talk all about one of the most powerful topical ingredients we use to treat melasma, hydroquinone, and the safety concerns surrounding its use. 

Okay, let’s dive into the topic at hand: just how SAFE is hydroquinone?

Hydroquinone is one of the most powerful topical ingredients when it comes to brightening dark spots, treating melasma, combatting hyperpigmentation and evening out skin tone. It’s available both as a prescription, often found in combination with other prescription medications like tretinoin, and is also available in OTC (over the counter) products. While it’s an incredibly powerful ingredient, and often considered first line by most dermatologists in the treatment of melasma, there are safety concerns surrounding its use. Does it get absorbed into the bloodstream? Can it cause cancer? Can it damage your liver? Should I be afraid to use it?  Having researched this ingredient extensively, and having used it in the office for over a decade, I will give you my honest opinion here.

First, should you be afraid of systemic absorption, and possible risks associated with systemic absorption? Many people aren’t aware that they are being exposed to considerable amounts of hydroquinone in their diet every single day. Hydroquinone is found in nature as either hydroquinone or arbutin, which is converted into hydroquinone in the body.  Hydroquinone and arbutin are found in tea, coffee, pears, wheat bread and red wine. Studies show that human exposure to hydroquinone from our diet is significant https://pubmed.ncbi.nlm.nih.gov/8568910/  I personally consume coffee and tea every day, and I love enjoying a juicy, ripe pear as a healthy snack.  

Does hydroquinone cause cancer or damage the liver? Most of these studies were done in rats, and many were done on populations of rats that already had predispositions for growing certain cancers and tumors. Although I certainly am not going to ignore these concerning studies, it is very hard to make a convincing case that what we see in rats will translate into humans. As far as liver studies go, hydroquinone seems to actually have a slight protective effect when you look at risk for liver cancers in rats. So clearly, we really are not certain of the true impact that hydroquinone has on our different organs. So far, studies done in humans who are exposed to higher concentrations of hydroquinone have been reassuring. I honestly don’t know any board certified dermatologists in the US who are afraid to use this ingredient because of concerns surrounding its “toxicity” to the body, after having reviewed the literature and science extensively.

What we do know is that high concentrations of topical hydroquinone, especially used for long periods of time without a doctor’s supervision, can lead to a skin condition called exogenous ochronosis, or pseudo ochronosis.  

This is when we see a darkening of the skin, even darker than the original melasma that these creams were meant to treat!  Furthermore, it is near impossible to get these stains to disappear!  

These cases, thankfully, are quite rare in the United States, and much more commonly found in parts of the world where people are also using antimalarial medications. Antimalarials also cause pseudo ochronosis, so the combination of hydroquinone plus antimalarials are probably a major risk factor for this condition.

The main risks seem to be: 

using concentrations higher than 4%

using hydroquinone for years at a time without breaks, and

combining hydroquinone with other ingredients such as oral antimalarial medications.  

We also know that many “bleaching” and “whitening” creams that you can find online or in other countries are contaminated with mercury and high potency steroids like clobetasol https://www.sciencedirect.com/science/article/abs/pii/S0013935116302651

Ok, so how do I approach hydroquinone in my office with my patients.  Here are my take homes:

  • Hydroquinone should only be used under the very strict supervision of a dermatologist
  • Each patient needs to weigh pros and cons, risks and benefits of using hydroquinone vs using other treatment modalities.  In cases where melasma is severe and affecting someone’s quality of life, the benefits may outweigh the risks. It’s a personal decision between that patient and the treating physician.
  • If you have been prescribed a hydroquinone containing prescription from your dermatologist, you MUST follow up carefully. Most derms will rotate you off of hydroquinone every few months, to make sure you get prolonged breaks between uses.
  • If you have used hydroquinone, or are using it, under the close supervision of a dermatologist, don’t lose sleep over it! Remember, everyone who is drinking coffee or tea, or eating pears or sipping on red wine, is also being exposed to hydroquinone.
  • Do NOT try to get hydroquinone containing products online or through online pharmacies.  If a friend brings you an extra “magic cream” across the border and swears by it, PASS!  Warn your friend about mercury and clobetasol and other risks she/he might not even know about.

For more recommendations and discussions surrounding melasma and hyperpigmentation, check out my IGTV and YouTube channels.

Dr. Whitney

 

 

Now that the warm summer months are becoming a distant memory for many of us, one major focus in my office is on hyperpigmentation that’s still lingering on my patients’ skin into the winter months. Specifically, melasma, also called the “pregnancy mask”, is common and can be incredibly frustrating. 

Melasma is a type of hyperpigmentation which is characterized by dark brown or gray-brown patches of skin on your cheeks, forehead, upper lip, or along the lower cheeks and jawline. My patients often describe it as having the appearance of “paint splatter” on their skin.  The excess pigment can be in the upper layers of your skin, or the deeper layers, or both. If you have excess pigment in the deeper layers, that can be much more challenging to treat.

A question I’ve been getting all the time on this subject is: Should I use retinol or bakuchiol if I have melasma?

Whereas retinol can be a bit of a diva in that it can be an irritant. Anyone who has tried a retinol has been there: you use it liberally for a few nights in a row and think: “No big deal! What’s all the fuss? My skin is doing fine.”  Then, about 4-5 days in, you find your regular moisturizer that you use all the time is making you red, blotchy and stings like crazy when you apply it. Then, you start to see the flakes, and you officially have a full blown case of “retinoid dermatitis!”

The new kid on the block, bakuchiol, is not irritating in the same way, and has been found to actually help soothe irritated skin!  When compared to retinol, bakuchiol is also very effective at reducing hyperpigmentation. This is so important because we know that irritation can actually exacerbate your melasma, making it worse. So although retinoids are so great at lightning the skin, it was always a delicate balance between getting the benefits without creating inflammation which we know could set melasma patients back.  

Now, we don’t have the same mountain of evidence for bakuchiol as we do for retinol because bakuchiol is so new on the scene, but the studies I’ve seen have been very, very promising and exciting on this front.

Also, bakuchiol is a great option for hyperpigmentation/melasma patients because it is not photosensitizing, meaning it won’t make your skin more susceptible to sun damage. Many retinol products, in contrast, are best used at night because they can make your skin more sensitive to the sun. 

Third, bakuchiol acts as an antioxidant, which is very beneficial for melasma patients given that oxidative stress and free radicals contribute to melasma. 

Finally, pregnancy and nursing often coincide with melasma (also known as the “pregnancy mask”), but we do not recommend use of retinol if you are pregnant or nursing. So, bakuchiol is a great option to help dial down melasma while you are pregnant or nursing. 

Here are some of my favorite bakuchiol products: 

Herbivore Botanicals Bakuchiol Retinol Alternative Serum-very lightweight, easily layers under your moisturizer.

Beauty Counter Countertime Tripeptide Radiance Serum 

You guys have asked so many great questions about melasma, so keep ‘em coming!

 

Dr. Whitney

Melasma (also called the “pregnancy mask”) can be stubborn and very frustrating for so many women. To address the questions I’ve been getting about melasma, I shared a series of posts covering this topic, including Melasma 101, 102, and 103.

Now, I’m sharing some brand new information. It’s not very often that we see new meaningful developments when it comes to treating melasma, so I am excited to share these new developments with you guys.

New Studies re: Antihistamine Use and Melasma:

If you have melasma, you might want to consider taking a daily antihistamine, like Claritin or Zyrtec. Why?

New studies are showing that there is an increase in mast cells in melasma.  Mast cells are cells that release histamine and other molecules that make you itchy and red – we usually think about mast cells when we think about allergies, but now we are seeing they play a role in melasma as well!

These mast cells can actually break down a type of collagen, collagen 4, which is found in the basement membrane of our skin. In melasma, the extra mast cells found in the skin release substances that chew away the membrane that separates the top layer of our skin from the bottom layer, called the dermis. When that happens, the pigment in our upper layers can drop down into the deeper layers, and that is NOT a good thing.

If you have melasma, your doctor might have told you that your pigment is DEEP, in the deeper layers of your skin, and that could be a reason why it’s so stubborn and not responding to therapy. So what if we could prevent the mast cells from destroying the basement membrane?  And, what if we could keep that pigment in the upper layers, where it’s easier to treat?

Well, there are ongoing studies looking at just that! They are looking at whether taking a daily oral antihistamine (like Allegra, Zyrtec, Claritin) might actually help with melasma. It’s worth considering if you have a very stubborn case. I will share more on this as the science develops!

Tranexamic Acid and Melasma

Another very new development in treating melasma is called tranexamic acid. It works as part of the clotting cascade, so it is FDA approved for conditions like heavy menstrual bleeding, or to help prevent bleeding in people with hemophilia, say when they’re getting a tooth extracted. In melasma, it works by basically dialing down the inflammation that leads to pigment production in the skin. It’s not FDA approved for melasma, so when it’s used for melasma, it’s considered “off label use.” With that said, we are starting to see very promising studies in connection with treating melasma.

Like any other treatment, this is something to raise with your doctor. This is not meant to be a first line treatment. It’s complimentary to all of the other tools used in melasma like brightening creams, sunscreen, Heliocare, and chemical peels. Also, it’s important to note that people who have a history of blood clots, dvt (deep vein thrombosis), are pregnant or nursing, or on birth control should not be taking prescription strength tranexamic acid by mouth. The topical, OTC form of tranexamic acid is newer (so we have less data at this point) and an option for people who are more comfortable using a topical cream vs an oral prescription drug, or for those who are not candidates for the oral form. Again, something to consider and to discuss with your doctor if you have very stubborn melasma.

Dr. Whitney

 

This morning, Ginger Zee and I shared a Facebook live focusing on melasma.

As Ginger and I discussed during our Facebook live, melasma, also called the “pregnancy mask” can be incredibly frustrating and emotional.

We received so many wonderful questions that I wanted to address them with comprehensive resources so you guys have this information at your fingertips!

To begin, I share all the basics about melasma, including what this condition is and what causes it, in my post, Melasma 101.

Next, I share my Melasma Game Plan in Melasma 102.  Specifically, I discuss sun exposure, heat exposure, and diet when it comes to keeping this condition under control! These are many of the points we discussed during the FB live.

And, in Melasma 103, I answer many of the questions I receive in the office and on social media about in-office procedures that can help, at home peels that can help, products I often recommend to my patients, and more! Many of these products are the ones that I discussed during our FB live and I include links.

The additional products I mentioned during the live are:

Naturopathica Vitamin C15 Wrinkle Repair Serum

Supergoop! Unseen Broad Spectrum SPF 40 

Glowbiotics Tinted Mineral Sunscreen with Iron Oxide

For more information like this, be sure to follow me on social media! My handle is @drwhitneybowe.

Have a wonderful day and keep your questions coming!

Dr. Whitney

You guys asked so many great skincare and skin health questions on my social media channels, so I wanted to share some of my responses right here!

Q: I suffer from Melasma and wonder if you recommend any supplements in addition to taking the normal precautions for Melasma?

Dr. Bowe: This is such an important topic and I’m so glad you asked. I have a series of three posts all about Melasma, my in-office strategies, and the products I typically recommend to my patients right on my website! Here are links that I think you will find helpful (my answer to your question is in Melasma 102)!! https://drwhitneybowe.com/melasma-101-understanding-this-condition/, https://drwhitneybowe.com/melasma-102-game-plan/, https://drwhitneybowe.com/melasma-103-q-a-with-dr-whitney-bowe/.

Q: Do you recommend Botox?

Dr. Bowe: Hi! I just did an interview all about Botox with my good friend, Julia Dfazic of Lemon Stripes! Here is a link: https://lemonstripes.com/lifestyle/botox/

Q: What skincare products to use to minimize acne scars from cystic acne?

Dr. Bowe: Excellent question – I have a post on my website all about cystic acne! Here is a link I think you will find helpful: https://drwhitneybowe.com/acne-q-a-focus-on-cystic-acne/.

Q: I love the dewy fresh glow for spring. How can I do that?

Dr. Bowe: ANSWER: I love it too! I was recently on Good Morning America demonstrating the HydraFacial, which I have found is really effective in achieving a healthy, radiant glow. Here are a few links on that: https://drwhitneybowe.com/dr-bowes-guide-to-the-facial-thats-been-making-a-splash-for-healthy-beautiful-skin-the-hydrafacial/ and https://drwhitneybowe.com/the-hydrafacial-a-healthy-beautiful-glow-this-spring/. Also, for a more comprehensive approach to your skin’s health, check out this post: https://drwhitneybowe.com/forget-8-glasses-of-water-a-day-why-drinking-even-a-bathtub-full-of-water-wont-give-you-the-dewy-healthy-skin-you-want/. I share a lot of information about nourishing your skin from the inside out on my website, my social media, and in my book, The Beauty of Dirty Skin. For a lasting healthy glow, I believe what you put into your body is just as important as the topical products you use on your skin!!

Q: What do you recommend for men’s razor bumps and rash?

Dr. Bowe: I recommend that my patients shave at the end of their shower or after getting out of the shower so that your skin has a chance to warm up. I also recommend using a very gentle exfoliant before shaving. You don’t want to aggravate and irritate your skin and hair follicles, but a gentle exfoliant can be very helpful, pre-shave. After you shave, I recommend a moisturizing lotion with antibacterial ingredients. If my patients have very sensitive skin, I often suggest staying away from heavily scented products, as they can be very irritating. I also always keep a fresh aloe plant in my house for all types of skin irritation. Smoothing fresh aloe over angry skin is my go-to at home remedy.

Q: Are there any over the counter facial exfoliating products gentle enough for Melasma?

Dr. Bowe: One option to consider is my Oatmeal Coconut-Oil Power Mask/scrub for sensitive skin. I include this recipe in my book, The Beauty of Dirty Skin. The oatmeal gently removes the dead cells on the surface to reveal your glowing skin underneath. You will need 1 tablespoon coconut oil (melt it down first), 3 tablespoons rolled oats and warm water. I typically advise my patients to leave it on for 15 minutes (and to gently exfoliate by rubbing in the mask in circular motions during application) and then rinse with cool water and pat dry. Or, you can simply use a baby washcloth for a gentle, mechanical exfoliation. In terms of an OTC option, I like this product by La Roche-Posay: https://www.dermstore.com/product_UltraFine+Scrub_27304.htm

Q: We are always told to reapply sunscreen after 2 hours. Does that mean 2 hours after application or 2 hours after sun exposure? I often put on sunscreen inside before I put on my bathing suit, but don’t immediately go outside. Same thing with my facial sunscreen.

Dr. Bowe: I look at the studies and the science before giving my recommendations. The standard rule of thumb at this time is to apply your sunscreen 15-30 minutes before heading outside and reapplying every 2 hours (more frequently if you have just gone swimming or if you are sweating excessively from exercise). Here is a study which is on point: https://www.ncbi.nlm.nih.gov/pubmed/11712033. With the FDA’s new proposed regulations and discussion of sunscreen safety (I will be sharing a lot more on this on my website), I often opt for UPF swimsuits, rashguards, and clothing for myself and for my daughter. We find they are a game changer in terms of enjoying our time at the beach or pool and minimizing the surface area we have to continuously cover with sunscreen!

Q: Is there a more cost effective alternate to CE Ferulic?

Dr. Bowe: CE Ferulic is one of my all-time favorite serums. While it is at a higher price point, it is just one of those products that I feel is worth the investment because it is effective and delivers results (admittedly, the scent is not my favorite aspect of the serum). For more cost effective options, my patients often love the No 7 serums. I share a lot of information about them on my Dr. Whitney’s Picks page: https://drwhitneybowe.com/dr-whitneys-picks/.

Q: Do you recommend a series of chemical peels or microneedling?

Dr. Bowe: My patients love in-office chemical peels. For dull, dry skin, I opt for a glycolic acid peel. For oily/acne prone skin, I focus on a salicylic acid peel. Both options will help boost your healthy glow (and if you are planning to wear makeup for an event, your makeup applicationwill be so much more smooth and beautiful). For an at home option, check out this “babyfacial” from Drunk Elephant. And, here is my post all about microneedling, which my patients love and we have wonderful results: https://drwhitneybowe.com/microneedling/. In terms of which one would best suit your needs? It will depend on your personal skincare goals and budget! I love both options!

There are a few questions I haven’t hit upon yet, so I will circle back to those very soon!

Dr. Whitney

Love hot yoga and love healthy skin? Keep reading!

Hot yoga  — so many people love it and don’t want to live without it! Did you know that hot yoga has been on the scene since the early 70s, but has been evolving on the regular? Over the years, heated studios have experimented with everything from room temperature (which ranges from around 90 to 108 or even higher) and appropriate poses to sweat-friendly gear and, most recently, their heat sources.

This latest hot yoga trend has some studios swapping out conventional forced-air systems for infrared (IR) heating ones. You’ll hear claims of all sorts of health benefits including increased metabolism and weight loss, improved flexibility, greater detoxification, and even reduced fine lines and wrinkles. People taking these hot yoga classes seem to love IR heat because it feels less heavy and oppressive than conventional heating methods and more like baking in the sun on a warm (okay, really warm) day.

This sun-like warmth makes perfect sense when you consider what infrared light is. It’s actually invisible, but IR light is felt as heat and is able to penetrate skin and heat even the deepest layers. In fact, about half of the sun’s energy is in the form of infrared. Which begs the question: Are we sure all this internal skin “baking” is safe/healthy?

“It really comes down to how controlled the ‘dose’ of IR energy is,” says Dr. Whitney Bowe, dermatologist and author of the new book The Beauty of Dirty Skin. “IR light-based therapies have been used clinically to promote wound healing, protect muscles from stress, and reduce inflammation. In fact, I use some IR devices in my office and recommend some at-home devices to my patients that are based on IR energy. But many people don’t realize that prolonged infrared exposure has detrimental effects on the skin.”

For starters, uncontrolled doses of infrared rays have been shown to damage skin by creating oxidative stress and free radicals, according to a research review in the journal Photodermatology, Photoimmunology & Photomedicine. Free radicals are highly reactive forms of oxygen that can damage cell membranes, DNA, and structural proteins like collagen and lead to premature aging, chronic skin conditions like acne, and even skin cancer.

“Extended exposure to IR energy has also been shown to alter the function of skin’s mitochondria, the powerhouses of cells, and stimulate the activity of enzymes called MMPs that degrade collagen,” says Dr. Bowe. “And high levels of IR heat can theoretically challenge the skin of anyone with a chronic condition that’s characterized by pigmentation, such as melasma and post inflammatory hyperpigmentation.”

At this point you’re probably thinking it’s time to turn in your IR hot yoga towel, but Dr. Bowe says it’s not necessary to give it up altogether unless you suffer from melasma. “I urge my patients to pause their passion for hot yoga. I’ve seen one hot yoga class take us back 6 chemical peels and 4 months of potent prescription peels,” says Dr. Bowe. Her advice: if you are going to keep up with a hot yoga routine, prioritize protecting your skin before you head in to the studio. And in fact, you should take precautions anyway: you’re getting hit with IR every day from other sources as well, namely the sun – and traditional sunscreens don’t protect against IR rays.

“I’m a firm believer in protecting the skin from uncontrolled IR rays using an outside-in and inside-out approach,” Dr. Bowe says. Here are the six smart skin strategies she recommends employing every day, even when you’re not rolling out your mat.

Apply a topical vitamin C serum.

Vitamin C is a potent antioxidant that stimulates collagen production and combats free radical damage from IR rays and – get this – exercise. “Your body produces free radicals through normal metabolic processes like respiration, so when you work out, you produce more free radicals,” says Dr. Bowe. Choose a lightweight serum that doesn’t clog your pores, and be sure to cover your face, neck, chest, tops of your hands, and any other regularly exposed skin.

Supplement with Heliocare.

This natural supplement contains a patented specialized extract of Polypodium leucotomos (PLE), a tropical fern native to Central and South America that’s been used for centuries as a remedy for various skin conditions. PLE’s powerful antioxidant properties help protect your skin from the inside out from free radicals. Dr. Bowe recommends taking one pill every morning; two if you’re heading out in the sun (but it’s not a substitute for sunscreen).

Sip a collagen smoothie.

Supplementing with collagen can help combat the wrinkling caused by IR heat exposure, says Dr. Bowe. It’s the main structural protein in skin, and its two main amino acids – proline and glycine – are essential for the formation and repair of healthy skin. “I like collagen powders from marine sources,” she says. “Marine collagen is smaller in molecular size than collagen derived from cows or pigs, so it’s more bioavailable and thus more likely to get into your bloodstream and reach the places where it’s meant to work its wonders.”

One of Dr. Bowe’s favorite smoothie recipes: Blend together 1¼ cups unsweetened almond milk; 1 tablespoon each of collagen powder, cacao powder, and almond butter; 1 small banana, frozen in chunks; ½ cup fresh or frozen blueberries; 1 cup loosely packed baby spinach; and 2 ice cubes (if using fresh blueberries).

Eat foods rich in vitamins A and C.

Both nutrients play a key role in boosting your body’s collagen. “Vitamin A helps restore and regenerate damaged collagen, and your body can’t even make collagen without vitamin C,” says Dr. Bowe. Dark leafy greens (such as kale, spinach, and chard) are high in both A and C. Top sources of C include oranges, red bell peppers, Brussels sprouts, strawberries, grapefruit, and guava. Foods high in vitamin A include carrots, squash, mango, and watermelon.

Get extra C.

Vitamin C is easily lost in urine, says Dr. Bowe, so in addition to eating C-rich foods throughout the day, she recommends supplementing with 1,000 milligrams of C daily.

Supplement with vitamin E, too.

Another powerful antioxidant, vitamin E stops the production of free radicals, and researchers are looking at E as a possible preventive measure for skin disorders associated with free radicals. It’s tough to get enough E in your diet – sunflower seeds and some nuts contain small amounts – and UV damage depletes our levels, says Dr. Bowe, so she recommends taking 400 IU a day.

Ultimately, whether you decide to stick with IR yoga or not, we all know we need to keep up our mind-body practices and our skin care regime. It’s a fact that doing yoga offers its own benefits, including reduced inflammation, lower levels of the stress hormone cortisol, and greater numbers of healthy mitochondria – all of which are associated with healthier, younger looking skin.  But when we are truly happy and find time for self-care you sport the Instagram-worthy natural glow. In sum: keep oming and keep glowing.

 

Dr. Whitney

You guys asked so many insightful questions about this subject, so I am answering a number of them here and then, we will also have another post, Melasma 104, in order to address the broader questions.

This Q & A is intended to empower you with knowledge and information to discuss with your physician. Without seeing each and every one of you in my office as a patient, I cannot provide personal medical advice. Instead, my goal is to share my knowledge and experience in order to serve as a guide for you – arming you with the knowledge you need to help make excellent medical decisions with your personal doctor.

Here goes!

Q: Which peels, lasers, etc would be safe for a patient with Melasma.

Dr. Whitney Bowe: I will address this question from an in-office and an at home perspective.

I offer superficial, medium and deep peels in my office. The depth of the peel plus the combination of ingredients has a major impact on which skin issues the peel addresses as well as how much downtime/recovery is involved post-peel. Many of my patients come into my office recounting the Sex and the City episode where Samantha had that horrendous chemical peel. As I tell my patients, not all peels are created equal, so you really want to be sure that you are in very experienced hands when it comes to these types of peels, particularly if you have Melasma.

Over the years, I’ve found that the best in office “peel recipe” for Melasma is a series of at least 10 monthly superficial peels. Superficial peels don’t penetrate too deeply into the skin, and the cumulative effect of these peels is more effective AND results in fewer side effects than a smaller # of medium or deep peels.

If someone with Melasma also has acne prone skin, or the type of rosacea that leads to swollen looking pores (what I call a peau d’orange, or orange peel appearance to the skin), then I begin with salicylic acid peels. Salicylic acid is incredibly effective at dialing down redness in the skin. It’s very closely related to aspirin on a molecular level, and we know aspirin is an amazing anti-inflammatory. My patients note that salicylic acid peels tend to be very calming and anti-inflammatory. These peels also typically don’t make you more sensitive to the sun, so these are my go-to peels all summer long.

If a patient presents with dry skin, and isn’t struggling with redness, then I might start with a series of glycolic acid peels. There’s a major misconception that the higher the percentage, the stronger the peel. However, it’s not just percentage that matters . . . it’s also the pH of the peel, and whether the peel is buffered or not. So you might go to a spa where an aesthetician is using a 70% glycolic peel on your skin, but that peel is very buffered and hence much weaker than a 30% peel I use in my office!

If you’re thinking about starting a series of peels with your practitioner—a few things to keep in mind and to discuss with your doctor:

  • I recommend that my patients refrain from using anything that could irritate your skin in the days leading up to the peel. I have my patients stop using any products containing retinoids or benzoyl peroxide four nights prior to peels in my office
  • Your skin should be prepped prior to the peel, to ensure it penetrates evenly. This step “degreases” the skin, so it removes any built up oils or sebum on the skin that might affect the peel’s ability to penetrate evenly.
  • My staff uses a barrier ointment to protect the delicate areas on the face where the acid can pool. They paint it on using a Q-tip.
  • Some peels are re activated by exposure to water, so be sure to ask how long to wait before sweating or exercising or washing your face again.

The peels you purchase online or over the counter, that are meant for at home use, tend to be much weaker than in office peels. However, you can still run into trouble. At home peels contain many of the same ingredients as in-office peels, so they do come with a risk of burn or skin irritation if used improperly. One at home salicylic acid peel that has consistently been given rave reviews by my patients is the Exuviance Performance Peel AP25. The ease of use is definitely a key feature of this peel, as you are using pads rather than a dropper. I often recommend that my patients start off trying these once per week to determine their skin sensitivity and to assess whether there is any reaction. Follow with a moisturizer, as these peels can be drying.

Q: What makeup is best to cover melasma? I noticed a lot of makeup brands sit on top and do not help cover.

Dr. Whitney Bowe: My patients with Melasma consistently love a product called Dermablend.

I also regularly recommend the Bobbi brown color corrector. I actually use this to cover up both uneven pigment AND broken blood vessels or red areas. Pat, don’t rub, onto spots that require coverage. Then use your regular foundation all over on top. I use this like a concealer/spot corrector.

And, here are a few makeup tips which I share with my Melasma patients: Always begin by using a moisturizing sunscreen underneath your foundation! Studies show that people use about 1/7th of the powder or foundation they need to get the SPF on the label – meaning, you would need to apply 7 coats of the makeup/powder you would normally use to get the SPF you think you’re getting. This is not true of moisturizing sunscreen/moisturizer with SPF so, I recommend beginning with this type of product, allowing it to absorb, and then applying your makeup on top. If your makeup also includes SPF, this would be icing on the cake.
Never rub your foundation. Instead, pat or blot it on with a sponge or fingertips. Rubbing can actually irritate/inflame your skin, which can make Melasma worse.

Q: I have heard microdermabrasion is helpful. Do you think so or could it make it worse?

Dr. Whitney Bowe: In my experience, Microdermabrasion can make Melasma worse, so I tend to avoid it in my Melasma patients.

Q: What is your recommended skincare routine, including ingredients, for patients with Melasma?

Dr. Whitney Bowe:

MORNING:

I always recommend that my Melasma patients begin with a Heliocare supplement every morning. Heliocare has been studied in patients with Melasma and a recent study (http://jcadonline.com/effectiveness-polypodium-leucotomos-extract-melasma-asian-skin/) demonstrated its efficacy when used in combination with sunscreen and hydroquinone.  Subjects who also took Heliocare, along with those other measures, actually had a faster response and accelerated brightening of their dark spots compared to those who took a placebo. Slow response to treatment is one of the most frustrating aspects of Melasma, so anything that is proven to safely speed along the progress is key!

In addition to taking a Heliocare supplement, I recommend that in the morning, my Melasma patients cleanse their skin with a gentle cleanser (ex: LRP) using fingertips only. Pat your skin dry (don’t rub). Next, you can add a couple of drops of your favorite Vitamin C Serum (see those listed below) into your moisturizer with SPF, or you can use a layering approach – apply your antioxidant serum first and then layer your moisturizer with SPF on top of it.  Follow with makeup per my description.

For my sun hat and lifestyle recommendations for patients with Melasma, please check out Melasma 101 and 102.

EVENING:

In the evening, I recommend that my Melasma patients alternate between an antioxidant serum like La Roche-Posay’s CE Ferulic or Dermalogica biolumin c serum and a retinol-containing product like dermalogica’s overnight retinol repair or one prescribed by your doctor.

Also, I usually prescribe a Melasma Emulsion – which my patients often mention on social media — or a BLEND of ingredients to use a few nights a week- talk to your derm about getting one customized to meet your needs. I choose from ingredients like HQ, kojic acid, tretinoin and hydrocortisone. I do not sell this emulsion on my website. This is an in-office customized prescription.

Dr. Whitney

What can I do to address my Melasma? The first thing I tell my patients is that we cannot “cure” this condition. BUT, we can get it under control. You have to be like a tortoise—slow and steady wins the race! Here is a step by step guide that I would discuss with my patient if she presented with Melasma:

1. Sun Exposure

  1. I recommend that my patients wear a broad-rimmed hat when they are outside during the summer months without exception. If someone looking at you can see a criss-cross pattern of sun on your face, that’s not effective enough. Here’s an example of tightly woven hats with built in sun protection: wallaroohats.com, coolibar.com, sunhatsbyronigirl.com.
  2. Of course, it goes without question that you have to wear a topical sunscreen and you should be generous with your sunscreen and reapply frequently. Many of my patients swear by mineral/physical blockers, as they find that the chemical blockers (even though they test incredibly effectively), seem to aggravate their Melasma symptoms. Think Sport and Pacifica are two brands which I regularly have in our family’s rotation.
  3. Seeking shade is non-negotiable. No matter how powerful your sunscreen, or how wide your hat, you must seek shade between the hours of 12 and 2. And not just under an umbrella. Studies show most beach umbrellas do NOT provide sufficient protection from UVA and UVB rays. I tell my patients to seek shade under a wood canopy or go indoors. REAL shade.
  4. Light reflects off of the water, so when you are swimming, even if you are wearing a hat, the rays are bouncing off the water and hitting your face. I recommend that my Melasma patients try to swim in the morning or late afternoon when the sun isn’t as strong – or opt to swim in the shady part of the pool.

Heat ExposureIf you feel heat on your face, that can make your Melasma worse. I have patients who are chefs, opening and closing the oven all day, and when they finally take a vacation from work their Melasma clears up simply because they aren’t getting that heat from the oven. Infrared heat can also make Melasma worse— that means infrared saunas and at home devices are NOT good for people prone to Melasma. Time to give up your hot yoga- most hot yoga classes are heated using IR devices. IR can also come from space heaters and certain hair dryers. Rule of thumb: if your face feels hot, chances are your Melasma is about to get worse.

Diet

  1. I recommend that my Melasma patients begin taking a Heliocare antioxidant supplement that works as a complement to your sunscreen to increase your protection from the inside out. This is not the type of “sunscreen pill” that the FDA warned about. See my post here about “sunscreen pills” (   https://drwhitneybowe.com/sunscreen-pills-are-they-putting-you-at-risk/).  Instead, Heliocare is a proven supplement, backed by science, which has shown to be highly effective.
  2. There are also some strains of probiotics that can boost the effect of your sunscreen and protect against UV rays from within. I include this information and examples in my book, The Beauty of Dirty Skin.

Thinking outside the boxUVA rays penetrate through window glass. You can get yours tinted with UV protective tints, or you can reapply your sunscreen every time you take a drive. Today, UV-screening residential and commercial film is available for home and office. UV absorbers are added to clear or tinted polyester or vinyl to create the film, which comes in varied tints, allowing 30-80 percent of visible light to get through. The installers apply it on the interior glass surface of the windows from flat sheets. Window film will help prevent sunburn and skin cancer, as well as the brief daily UV exposures that accelerate skin aging over time. To learn more, check out this link on skincancer.org.

@DrWhitneyBowe

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