7 Ways to Treat Melasma

Melasma: What is it and how do I treat it?

Melasma (aka cholasma or mask of pregnancy) is an acquired hyperpigmentation of the skin, usually in sun-exposed areas such as the face.  The darkening of the skin is caused by an increase of melanocytes (the cells that color our skin).  Although we don’t know what causes melasma we do know there are some common contributing factors.  It is most common in pregnant women (thank you, hormones), people with hormone imbalances, people on oral birth control, and people with darker skin tones.   Many people find the darkening of their skin disturbing and upsetting.  It can cause depression, social inhibition and embarrassment.  Melasma can be difficult to treat and often requires a multifaceted approach to help the skin return to its original state.


Treatment options:

Camouflage it! Cover the area with makeup.  This is an easy, at home ‘treatment’ but can be time consuming.  It is by far the least invasive.  It is worth getting help with finding a foundation that blends well with your skin.

Skin lightening agents: these are topical treatments that are applied to the skin daily.  They work by blocking an enzyme important to synthesize melanocytes (the cells that darken our skin).  They can cause irritation, burning, scaling, redness, and itching. These typically take more than 6 months to notice a change in the skin, they need to be used for many years and cannot be used continuously (you must take a break from them periodically).   

Topical retinoids: Like the skin lightening agents retinoids are applied topically.  Our bodies make them naturally when we eat foods high in vitamin A.  Retinoids are important for cell-to-cell communication, help regulate cell proliferation and growth of the skin cells.  These topical agents are created in a lab.  These topicals are NEVER used to be used in pregnancy or someone seeking pregnancy.  As will all topical agents they can cause irritation.

Combination therapies: combination skin lighteners plus retinoids seem to have the most promising results. Side effects are the same as above.

Chemical peels: the research is very mixed for the efficacy of chemical peels.  It is inconsistent but does work for some people.  Again, irritation and burning are the biggest complaints.

Laser/Light therapy: This treatment works well for patients who have tried #allthethings first.  Light therapy can cause redness, scaling, drying, burning, swelling, hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin.  So, it could help but could also make it worse.

PRP (Platelet-Rich Plasma) injections and microneedling: Although the research is limited PRP is a very promising treatment option.  First, it works by using your own body’s mechanism of skin/tissue repair.  Second, there are no added irritating chemicals/agents.  It works best with 3 treatments one month apart each.  Side effects are mild redness and/or swelling that resolve within 24 hrs. 

Remember to avoid the sun during treatment.  Many of the treatments increase sun sensitivity therefore exposure could potentially increase symptoms. Use an organic, zinc based sunscreen and wear a hat whenever out in the sun to prevent premature aging and hyperpigmentation of the skin

**Also, there are lots of other causes for darkening of the skin (hyperpigmentation) so be sure to chat with your doctor before trying treatments.

Facial Rejuvination: The ("Vampire") Facial


Skin.  We are covered in it and we want it to look good.  It is also our first line of defense against pathogens so we want it to be strong.  When we are young strength and smooth appearance are not a challenge. However, over time as we age the skin looses elasticity, collagen, extracelluar matrix which cause thinning, fine lines, wrinkles, changes in color, and tone.  The loss of these substances also weakens the barrier effect of the skin.  While we are supposed to age and grow old most of us want to do so gracefully while retaining our youthful appearance as long as possible.  In steps Platelet-rich Plasma and the "vampire" facial.

What is Platelet-rich Plasma?

Platelet-Rich Plasma (PRP) is a non-operative treatment for patients seeking to improve tissue healing.  Originally, PRP was used for closing surgical wounds. For many years it has been used with success for healing joint injuries previously thought only to be repaired with surgery.  Most recently, PRP is being used to improve skin texture, tone and appearance.  Derived from the patients own blood, PRP, is rich with growth factors that regulate cell migration, proliferation, remodeling of the extra cellular matrix and promote wound healing(1). By putting the PRP at the desired site (in this case, the face, neck, décolleté, hair, back of hands, old scars) the growth factors will call into action a process of repairing, rebuilding and healing the area.    

What is a "vampire" facial?

Platelet-rich plasma (PRP) for skin is excellent for a variety of conditions.  A "vampire" facial is a non-operative skin treatment using PRP (blood) on the face, neck, décolleté and back of hands to decrease appearance of wrinkles, improve elasticity, tone and texture, reduce pore size and fine lines, increase vitality and brightness of the skin (2). People with acne scarring can improve the discoloration and depth of scarring.  When used on larger scars it can soften and smooth the scar allowing for more flexibility of tissue.  Patients experiencing hair loss or hair thinning can have PRP treatment on the scalp to stop thinning or regrow hair(3,4). Using PRP in conjunction with lifestyle modifications patients will see the greatest improvement.

What Will the Treatment Be Like?

At your visit for PRP you will have a small amount of blood drawn which will then be prepared in the lab.  Once prepared, the physician will inject the PRP just under the skin throughout the face/scalp/neck using very small needle.  The procedure takes about 1 hour and you will be able to return to your day once complete.  You may have some redness and feelings of fullness in the face.  This is normal and will resolve within 1-3 days.  Please do not apply anything to the skin after the treatment until the following day.  Wear an organic, mineral based sunscreen or keep the area covered to protect the skin. You may notice skin improvement within 48 hours and your skin with continue to improve over the following 6 weeks.  It is recommended to have a series of 3 treatments 6-8 weeks apart for the most optimal results.

Is it safe?

PRP is extremely safe.  It is derived from the patient’s own blood.  Therefore, the body will recognize the solution reducing the risk of complications.  There is no down time for a PRP procedure and patients can return to life/work immediately. Adverse effects are mild bruising at site of blood draw or at injection sites, mild redness, itching, sensation of fullness in face.  All of these adverse effects are limiting to 1-3 days and most resolve within 24hours.



  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539389/
  2. https://www.ncbi.nlm.nih.gov/pubmed/28382785
  3. https://www.ncbi.nlm.nih.gov/pubmed/29707872
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539389/

Sun-Kissed but Safe

SUMMER! It has (sort of) arrived in the Pacific North West!  To me, summer means river swimming, gardening, grilling food, lots of outdoor time, and SUN (not something we see year round here).  To that end this post is about sunscreen and why you should wear it. 

Please, wear sunscreen but not all the time.  Exposure to sun is necessary for the production of 25-hydroxyvitamin D or vitamin D(1).  Vitamin D is essential for the immune system, bone health, brain functioning, and prevention of chronic illnesses.  Studies show that short ‘doses’ of sun exposure consistently are helpful for producing vitamin D(2).  Doses are different for every person but we all need some sun exposure.

Choosing your sunscreen

There are hundreds of sunscreens on the market.  Each one touting its own superiority.  However, the ingredients do matter. This product is going on your skin or the skin of your loved ones.  Look for an organic mineral based sunscreen with zinc oxide or titanium oxide as the UV protection.  Both zinc and titanium oxides cover the full UV spectrum and offer the best protection(1). Sunscreens protect against UVA and UVB rays. UVA rays cause premature aging and wrinkling of the skin.  UVB rays are responsible for sunburn(3).  BOTH UVA and UVB contribute to skin cancer.  This is why you’ll want a ‘Broad spectrum’ sunscreen. 

 Even more preferable is one with other nutritive ingredients so that you’re protecting and nourishing the skin at the same time.  Also be sure the sunscreen you choose is ‘water resistant’(4). 

SPF matters

SPF is the level of protection from UVA2 and UVB rays(1).  SPF 30 is twice as protective as SPF 15.  SPF 30 is recommended for most people on a daily basis.

Timing is important.

For maximum protection it is recommended to apply sunscreen 15-20 minutes before prolonged time in the sun(1)


Reapply sunscreen every 1-2 hours when in the sun for prolonged periods, when sweating or when swimming.

Alternative ways to protect yourself from sun

Sunscreen is helpful but certainly not the most optimal or convenient way to protect yourself from the sun.  Wearing clothing over areas exposed to sun is preferable. Using hats to shade the face and choosing shady locations for play and leisure are more likely to keep your skin sunburn free. 



·      Get some sun daily but only a little to help produce vitamin D

·      Wear sunscreen daily and a hat

·      Choose a mineral based, broad spectrum, water resistant SPF30 sunscreen

·      Reapply every 60-90 minutes

**If you’re wondering what I use it’s THIS by Willamina Modern Apothocary.  I love it.  Its emollient properties mean it absorbs into my skin well without leaving that “I’m wearing sunscreen” feeling.  Plus, I don’t need an additional moisturizer.  Also, the ingredients are very nourishing for the skin and add to my skin health while protecting it.  You can pick it up in office at Wild Heart Medicine or order online.



1.     https://www.uptodate.com/contents/selection-of-sunscreen-and-sun-protective-measures?search=sunscreen&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H63385731

2.     https://www.health.harvard.edu/diseases-and-conditions/benefits-of-moderate-sun-exposure

3.     https://www.health.harvard.edu/cancer/how-to-choose-and-use-sunscreen

4.     https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent/how-to-select-a-sunscreen

The Do Nothing Project

The Do Nothing Project

By now, you’ve heard about mindfulness/meditation.  It’s a hot topic in the ‘wellness community’ with vast research supporting it for stress reduction, improved focus and mood, memory improvement, better sleep, decreased blood pressure, increased immunity, increased grey matter in the brain. There aren’t any real negative side effects of taking up a meditation practice other than that people may be mad at you for not answering their texts/email immediately (to mitigate this, practice in the early morning).

BUT, if you are like me, the image I have of what meditation is ‘supposed’ to be makes me so irritated. Cue eye roll.  It feels unachievable and woo woo.   People who love it sound preachy to me, “you know what you should do? Meditate!” More eye rolling.

To consider a mindfulness practice I had to reframe the situation into “I’m doing nothing.”

In his TEDtalk, Andy Puddicombe, the mind behind Headspace (book, app, website), discusses the importance of 10minutes of doing NOTHING daily.   If you’re like me, 10 minutes of nothing sounds so hard and boring and frustrating.  You can watch his TEDtalk here

If we change our ideas of meditation to ideas of DO NOTHING we can still get the benefits of meditation.  To do NOTHING means to be in a moment without productivity,  attachment or outcome.  This can be staring off into space, walking, sitting in meditation, listening to music, folding laundry, staring at the clouds...

Read about Why it’s so hard to let ourselves do nothing here.

My challenge to you (and myself): For ONE week (7 days in a row) set a timer for 3 minutes and DO NOTHING.

Tips for success:

o   Schedule it for the same time everyday (morning is often easiest for many people)

o   Be upright so you won’t asleep

o   Use the restroom and drink some water before starting


3 minutes doesn’t sound long but many people will find it difficult and frustrating to start.  That’s ok.  Keep going and keep practicing every morning.  I will be doing it with you.                       

Love meditation? Tell me about your practice

Want more? Check these out:


Headspace app for phones

Podcast: 3-minute Hypnosis