Why people are asking about melasma now
Few skin concerns frustrate patients in Dubai and across the UAE as much as melasma. The patches fade, then return. A treatment seems to work, then the colour creeps back after a holiday, a hot summer or a hormonal change. If that sounds familiar, you are not doing something wrong. Melasma behaves differently from most skin concerns, and understanding why is the first step to managing it well.
What melasma is
Melasma is a long-term, acquired condition in which patches of extra pigment appear on sun-exposed areas, most often the face. It is more common in women and in people with darker skin tones. It is not harmful and not contagious, but it can affect confidence, and it is difficult to treat. The word that matters most is chronic: the aim is control, not a one-time cure.
What can trigger it
A 2024 clinical review describes several associated factors:
- Sun exposure: cumulative ultraviolet (UV) exposure is a known driver.
- Visible light: light in the 400 to 700 nm range can also stimulate pigment in susceptible skin.
- Hormonal changes: pregnancy and use of the contraceptive pill are linked to melasma.
- Heat: heat exposure is a recognised factor.
- Family history: melasma tends to run in families.
In a climate with strong sun and high temperatures for much of the year, daily protection is not optional. It is part of the treatment.
How a physician-led plan works
A good melasma plan rests on three ideas: protect, treat and maintain. The aim, as with the approach we describe on our treatments page, is control, maintenance and skin tolerance rather than chasing a quick result.
Protect. Broad-spectrum sunscreen is the foundation. Because visible light can trigger pigment, tinted sunscreens containing iron oxide are of particular interest, and in one trial they outperformed sunscreens without it. Mineral sunscreens (zinc oxide, titanium dioxide) are also recommended because they help block visible light.
Treat. Treatment is selected after assessment and may include:
- Topical hydroquinone (commonly 4%), long regarded as the comparison standard, often used with a retinoid.
- Triple combination creams (hydroquinone, a retinoid and a mild steroid), which are widely used but need supervision because side effects such as skin thinning and visible small vessels become more likely with continuous use beyond about three months.
- Other topical agents such as azelaic acid, kojic acid, niacinamide, cysteamine and others, though many of these studies are small.
- Oral tranexamic acid, which is considered in some cases after medical screening. It is not suitable for everyone, so it should only be used under medical supervision.
- Selected laser or light treatments, used cautiously and only in the right patient.
Maintain. This is where most plans succeed or fail. Relapse after stopping treatment is common in clinical trials, so ongoing sun protection and a maintenance routine are central. Some maintenance regimens using triple combination cream a couple of times a week have been studied to help prevent relapse in more severe cases.
Who may benefit from a melasma plan
- People with symmetrical brown or grey-brown patches on the cheeks, forehead, upper lip or jawline.
- Patients whose pigment worsens with sun, heat, pregnancy or hormonal medication.
- Those who have tried products or treatments that brought temporary improvement followed by relapse.
- People who are ready for a long-term plan with regular follow-up.
A clinical assessment matters, because not all dark patches are melasma. Sun damage, post-inflammatory pigmentation and other conditions can look similar and need different approaches.
What the evidence actually says
Melasma has a decent range of treatment options, but the evidence has real limits. The 2024 review in the American Journal of Clinical Dermatology describes melasma as difficult to treat with a high risk of recurrence. Many of the trials it cites are small, often 20 to 50 participants, and several are single-arm or split-face designs, so results should be read with that in mind.
Some specific points from the reviews:
- Hydroquinone is described as the gold-standard comparator, but irritation is the most common side effect, and a rare condition called exogenous ochronosis (a bluish-black darkening) has been linked to long-term or unsupervised use, especially in skin of colour.
- Topical tranexamic acid results vary by concentration and formulation. One split-face trial found 3% comparable to 3% hydroquinone with dexamethasone and with fewer side effects, while another found 5% no different from vehicle.
- A 2019 literature review (Spierings) suggested low-fluence Q-switched lasers appear to be the best laser and light option at present, while intense pulsed light shows only minimal improvement and needs topical maintenance, and some other lasers showed limited benefit or insufficient evidence. It also notes that peels are not superior to topical therapy and carry a higher risk of post-inflammatory hyperpigmentation.
The honest conclusion: no single treatment is guaranteed, results vary from person to person, and relapse is common even when treatment goes well.
What happens at your consultation
A good assessment usually covers:
- Your history: sun habits, pregnancy, hormonal medication, family history, previous treatments and reactions.
- A skin examination, sometimes with imaging, to separate melasma from other pigment conditions.
- Your skin type and how likely it is to react to certain treatments.
- A step-by-step plan that starts with protection and the gentlest effective approach, with review points.
Realistic results and timeline
Melasma responds gradually. Topical plans are typically judged over months rather than days, and some guidance suggests first-line topical therapy for at least three months before judging response. Improvement may be partial, and maintaining it is part of the plan. Expect patches to lighten and to be able to return with sun, heat or hormonal changes. Results vary.
Side effects and safety
- Irritation: redness, dryness, peeling and stinging are common with active topicals.
- Hydroquinone: long-term or unsupervised use carries a risk of ochronosis.
- Steroid-containing creams: can thin the skin and cause visible small vessels with prolonged use.
- Peels and lasers: the wrong choice or settings can trigger post-inflammatory hyperpigmentation, which can leave the area darker than before. This is why aggressive treatment is not the answer, and why one 1550 nm laser type was reported as neither effective nor safe for melasma.
- Oral tranexamic acid: requires medical screening, as it is not appropriate for people with certain clotting risks.
Who should avoid or delay treatment
- People who are pregnant or breastfeeding should avoid several melasma medicines and discuss options with their doctor.
- Anyone with an allergy to an ingredient in a proposed treatment.
- People with active skin infection, open wounds or severe inflammation in the area, until healed.
- Those with a history of blood clots or clotting disorders should not use oral tranexamic acid without specialist advice.
- Anyone unable to commit to daily sun protection, since treatment without it is unlikely to hold.
Comparison with alternatives
- Topical plans: the usual starting point, lower risk, need patience and maintenance.
- Oral options: considered in selected patients after screening.
- Chemical peels: may help some patients but are not superior to topical therapy and carry a higher risk of rebound pigmentation in darker skin.
- Lasers and light devices: can be useful in selected cases, but results are mixed and relapse is common, so they are usually added to, not replaced for, a protection and topical plan.
- Doing nothing but sunscreen: surprisingly valuable, and a sensible baseline for any plan.
Questions to ask before booking
- Is this definitely melasma, and how did you confirm it?
- What is the plan, and how will we judge whether it is working?
- Which treatments carry a risk of worsening pigment for my skin type?
- How long will I need maintenance, and what will it involve?
- What happens if I get irritation or darker patches?
- Which products do you use, and are they licensed in the UAE?
FAQs
Can melasma be cured?
It is a chronic condition. Many people achieve good control, but relapse is common, so maintenance matters.
Will sunscreen alone fix it?
No, but it is the foundation. Without it, other treatments are unlikely to last.
Can lasers make melasma worse?
Yes. The wrong laser or settings can trigger more pigment, so treatment should be chosen carefully after assessment.
Does it come back after treatment?
It can. In several trials, melasma relapsed after treatment stopped, which is why a maintenance plan is part of care.
How long until I see a difference?
Usually months rather than days. Your doctor will set expectations at your consultation.
Book a consultation
If dark patches keep coming back, a clear diagnosis and a physician-led plan can make a real difference. Book an assessment with Dr. Pravin Kumar to review your skin, your triggers and your options, and to hear honestly what is realistic for you.
Book a consultation at drpravinkumar.com
Sources
- Gan C, Rodrigues M. An Update on New and Existing Treatments for the Management of Melasma. American Journal of Clinical Dermatology, 2024
- Dermatology Times, Melasma Treatment Ladder (summary of Spierings, Journal of Cosmetic Dermatology, 2019)
Disclaimer: Educational information only, not medical advice. Results vary. Risks, contraindications and suitability are confirmed after an in-person assessment. Product availability and regulatory status vary by country.