Melasma is most common in people who tan easily or have naturally brown skin, Fitzpatrick phototypes III and IV, which describes a very large share of the population living in the Gulf. It is more common in women than men, typically starting between 20 and 40, and it is driven by sun exposure in a way that matters practically: both ultraviolet and visible light promote the melanin production behind it.

That last point is the one that changes what you should actually do. A standard sunscreen filters UV. Visible light passes through it. This is why melasma advice specifies a sunscreen containing iron oxides, and why people who diligently apply an ordinary SPF still watch their patches darken every summer.

Key takeaways

  • It favours the skin types most represented here. Most common in Fitzpatrick III and IV; less common in fair skin (I, II) and in black skin (V, VI).
  • Visible light matters, not just UV. Both promote melanin production, which is why the recommended sunscreen contains iron oxides and is SPF50+.
  • Sun protection is year-round and lifelong, not seasonal.
  • Hormones are implicated in about a quarter of affected women, including pregnancy, oestrogen or progesterone contraception, implants, IUDs and HRT.
  • Family history is strong. 60% report affected family members.
  • The most successful topical treatment is a combination of hydroquinone, tretinoin and a moderate-potency topical steroid, reported to clear or improve 60 to 80%.
  • It relapses. Even after a good result, pigmentation may reappear on exposure to summer sun.
  • Perfumed products can trigger it through a phototoxic reaction.

What is melasma, and how do I know that is what I have?

A common acquired skin disorder presenting as blotchy, brownish facial pigmentation, usually symmetrical on both sides of the face.

DermNet describes it as bilateral, blotchy, brownish facial pigmentation. It was once called chloasma and is still widely known as the “mask of pregnancy”. It can also appear outside the face in sun-exposed areas: forearms, upper arms and shoulders.

It is separated into epidermal, dermal and mixed types depending on how deep the extra melanin sits. That distinction is not academic, because it predicts how well treatment will work. Pigment sitting deeper in the skin is much harder to shift, which is one reason two people on identical treatment get different results.

Melasma is not the only cause of facial darkening, and the others are treated differently. Post-inflammatory hyperpigmentation following acne, drug reactions and other pigmentary disorders can look similar. A dermatologist can distinguish them, and that matters before starting a skin-lightening regimen.

Why is it so common in this region?

Because the two strongest drivers, skin phototype and sun exposure, both point the same way here.

Melasma is most common in people who tan easily or have naturally brown skin, Fitzpatrick types III and IV. That describes much of the South Asian, Arab, Filipino and Mediterranean population of the Gulf. It is less common at both extremes: fair skin (types I and II) and black skin (types V and VI).

Add the sun. DermNet describes melasma as proposed to be a photoageing disorder in genetically predisposed individuals, where ultraviolet and visible light promote melanin production. A region with intense year-round light delivers that exposure continuously rather than seasonally.

The genetic component is substantial: 60% of people with melasma report affected family members. If your mother or sister has it, your risk is not average.

Why is my sunscreen not working?

Because most sunscreens are designed against ultraviolet, and visible light also drives melasma.

This is the most actionable fact in the subject and it is routinely left out of general skincare advice. The recommendation is specific:

  • Broad-spectrum, very high protection factor, SPF50+
  • Containing iron oxides, which is what provides meaningful visible-light protection
  • Combined with a broad-brimmed hat and sun-sensible behaviour
  • Year-round and lifelong, not just in summer

Iron oxides are what makes a sunscreen tinted, which is why tinted mineral sunscreens are recommended for melasma while clear chemical ones often disappoint. If your sunscreen is invisible on the skin, it is probably not giving you visible-light protection.

Indoors is not automatically safe either. Visible light comes through windows, and the shaded-but-bright environments common here still deliver it.

Could my contraception or HRT be involved?

Possibly. Hormones are implicated in around one quarter of affected women.

DermNet lists pregnancy and the use of oestrogen or progesterone-containing oral contraceptives, intrauterine devices, implants and hormone replacement therapy as implicated in about a quarter of affected women. It also notes that thyroid disorders can be associated with melasma.

Among the general measures for treatment is to discontinue hormonal contraception if possible. That “if possible” is doing real work: it is a decision to make with a doctor, weighing what the contraception is for against how much the melasma is affecting you. It is not a reason to stop something abruptly.

Two other triggers worth knowing: some medicines, including newer targeted cancer therapies, and perfumed soaps, toiletries and cosmetics, which can cause a phototoxic reaction that triggers melasma. If you use scented products on your face and have melasma, that is worth changing before escalating treatment.

What actually treats it?

A combination, because no single measure does enough on its own.

General measures come first and are not optional: the sun protection described above, considering hormonal contraception, and cosmetic camouflage where wanted.

Topical therapy. The most successful formulation has been a combination of hydroquinone, tretinoin and a moderate-potency topical steroid, reported to clear or improve melasma in 60 to 80% of cases. That is a prescribed combination, used under supervision, not something to assemble yourself, and topical steroids on facial skin need a clinician deciding potency and duration.

Other topical agents, used alone or more commonly in combination, include azelaic acid, kojic acid, thiamidol, cysteamine, ascorbic acid, tranexamic acid, methimazole, glutathione and soybean extract.

Two cautions specific to this area. Skin-lightening products sold informally can contain undeclared ingredients, including unlabelled steroids or mercury, and the consequences of long-term unsupervised use include the pigmentation getting worse. And treatment aimed at pigment can itself provoke pigmentation if it irritates the skin, which is why “stronger and faster” is the wrong instinct here.

Will it come back?

Very likely, and knowing that in advance is part of the treatment.

DermNet is candid: melasma can be frustrating to treat for both patient and practitioner, it is slow to respond, especially if it has been present a long time, and even in those who get a good result, pigmentation may reappear on exposure to summer sun. The chronicity and relapse risk, with the need for lifelong sun protection, should be emphasised to set realistic goals.

So the honest framing is management rather than cure. The people who do best are those who treat sun protection as permanent rather than as something that accompanies a course of cream.

Do and don’t

Do:

  • Use SPF50+ broad-spectrum sunscreen containing iron oxides, year-round.
  • Wear a broad-brimmed hat and avoid peak sun.
  • Get the diagnosis confirmed, since other pigmentary conditions look similar.
  • Discuss hormonal contraception or HRT with your doctor as a possible factor.
  • Switch to unscented facial products.
  • Expect slow improvement and plan for maintenance.

Don’t:

  • Don’t assume an ordinary clear sunscreen is enough.
  • Don’t buy unregulated skin-lightening creams from informal sellers.
  • Don’t use a potent topical steroid on your face without supervision.
  • Don’t escalate treatment because it is working slowly.
  • Don’t stop hormonal contraception abruptly without advice.

Frequently asked questions

Is melasma dangerous? No. It is a pigmentary disorder, not a cancer or a sign of one. The reason to have it assessed is to confirm the diagnosis and to avoid treating the wrong thing, since other causes of facial pigmentation exist.

Will it fade after pregnancy? Melasma that appears in pregnancy often improves afterwards, but not always and not entirely, and it can recur with later pregnancies or hormonal contraception. Sun protection during and after makes a difference either way.

Do laser treatments work? They are used, but melasma is notoriously prone to rebound and lasers can worsen pigmentation if wrongly chosen. This is a decision for a dermatologist who has assessed whether your pigment is epidermal, dermal or mixed, not a walk-in purchase.

Where to go next

The skin care category is our second largest and lists what is stocked here, and melasma approaches it from the diagnosis. Sun and heat affect medicines as well as skin, which is covered in storing medicine in a Gulf summer.

MedicForce option: our skin listings are organised by active ingredient and strength, which matters for a condition where the same ingredient is sold at several concentrations.