A new crop of tasteful—and even chic—UPF options, coupled with some very real concerns about a new constellation of freckles, have made me rethink my position on covering up in protective clothing. “You need to tap into the vanity of it,” Whitney Bowe, M.D., says of a more general uptick in the popularity of UPF clothing that she’s seen among her patients as a steady stream of new brand samples continues to flood her office. “People are just more aware now, not just of the risks of skin cancer but also the risk of aging from the sun,” adds the Manhattan-based dermatologist, who cites dark spots, fine lines, wrinkles, and crepiness as chief offenders. Combined with rising environmental concerns about the harmful chemicals in many sunscreens, which prompted Hawaii to pass a landmark bill this month prohibiting the sale of formulas containing two major ingredients found to seriously impact coral reefs, and it’s little wonder that interest around UPF clothing is swirling.
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.
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:
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.
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.
When it comes to sunscreen, we have to remember that infant skin is different than adult skin. Infant skin is much thinner – it protects the body less effectively against outside agents, including chemicals in sunscreen. This is why we see these reports of severe, blistering burns or rashes in very young children when parents use the same sunscreen product on their older children and themselves without issue.
If you have a child under 6 months old, the US Food and Drug Administration and The Skin Cancer Foundation recommend keeping your child in the shade rather than using sunscreen, even physical blockers like zinc oxide. For children over 6 months, I recommend a patch test to make sure that your child is not particularly sensitive, or even allergic, to the ingredients in a particular sunscreen product. This could mean the difference between a sun safe child and a trip to the hospital with blistering, swollen skin.
A few months ago, I posted about this innovative new technology which was on the horizon and now, it’s here!!
As I discussed on Good Morning America today, sunscreen brand La Roche-Posay has developed the “MY UV Patch” which you wear on your skin. The patch is like a little sticker and it’s about ½ the thickness of a human hair, but it’s a very smart sticker! The sticker and its accompanying App monitor the amount of UV exposure you’re getting in real time.
In my practice, I see so many patients who have a tan or sun spots and swear “but I’m NEVER in the sun!” I think this patch will help educate people on how easy it is to accumulate UV exposure even on shady days. It will help you learn when you’re getting the most rays– on your way to work? During your lunch break? Sitting next to the office window at your desk? I think you’ll be surprised!
It will also help you determine WHERE you are getting those rays. People wear products with sunscreen plus makeup on their faces, but often neglect their chests and the tops of their hands, which speeds up aging on those skin surfaces.
As I discussed on air, the patch is water resistant so you can shower and swim with it, exercise with it, and even apply sunscreen directly on it. One really cool aspect of the patch is that you can see how well your sunscreen or SPF makeup is performing at screening out UV rays by monitoring your patch. Burning through your sunscreen? Test your sunscreen on top of the patch and see if it truly delivers. Your makeup says it has SPF 30 in it? Apply it to your patch and see if your patch agrees! So, it will help you figure out which products actually live up to their claims.
Knowledge is power, and this is one more very innovative tool to raise awareness when it comes to sun exposure!