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.