Melasma in a sunny climate: sunscreen, heat and treatment in Dubai

Melasma, chloasma, sun spots or hyperpigmentation: which is it?

Melasma, also called chloasma, or the “mask of pregnancy” when it appears then, is a pattern of brown or grey-brown patches, usually on both cheeks, the forehead, the nose, the chin or above the upper lip. It is much more common in women and in medium and darker skin tones, but men get it too, with the same features and triggers; in studies of men, sun exposure and outdoor work were two major risk factors. Sun is its main outside trigger, and hormones (pregnancy, the contraceptive pill, hormone therapy), family history and inflamed skin, including after cosmetic procedures, play a part.

Hyperpigmentation is the umbrella term for any patch darker than the skin around it. Sun spots are separate, well-defined marks built up over years of sun, and the dark marks left by acne or irritation usually fade on their own, if slowly. Melasma usually doesn't while its triggers last, though it may lighten after a pregnancy or after stopping the pill. Many people have more than one kind, which is why a doctor looks before anything is chosen.

Why melasma is harder to keep down in Dubai: UV, visible light and heat

On satellite estimates for clear days, Dubai's midday UV index is about 11 to 12, extreme, from April to August, and still about 5 in December and January. UV is only part of it. Visible light, the light we see by, also darkens pigment on medium and darker skin: in laboratory studies it caused pigmentation only in medium and darker skin types, and in one, blue-violet light left pigment that lasted three months. Heat may add to it. The sun's infrared has not yet been studied properly in melasma, but in a survey, more severe melasma went with heat at work.

Car windows are the detail people miss. In a study of 29 cars, windscreens blocked about 96% of UVA, the longer UV rays, but side windows blocked anywhere from 44% to 96%, and visible light passes through glass. Hours at the wheel keep one side of the face in the light, so sunscreen goes on before the drive, not only before the beach.

What type of sunscreen is good for melasma and hyperpigmentation on the face?

• Broad-spectrum, so it covers UVA as well as UVB, with an SPF of 30 or more; around treatments we ask for SPF 50. SPF 30 blocks about 97% of UVB, higher numbers block slightly more and last no longer, and no sunscreen blocks everything.
• Tinted, with iron oxides. The tint blocks part of the visible light that darkens melasma. In a trial in 68 people with melasma, all using a prescription lightening cream, those given a tinted SPF 50 with iron oxides improved more over eight weeks than those given a UV-only SPF 50, and trials of such sunscreens have found fewer relapses.
• Water-resistant, because a Dubai day means sweat, and in a texture and shade you will wear every day: the sunscreen that works is the one you put on.
• Gentle. Fragrance-free products suit reactive skin, and a sunscreen that burns or stings is irritating your skin, which can darken melasma.

Even a tinted sunscreen doesn't block all visible light, which is why shade, a wide-brimmed hat and less time in the midday sun still do much of the work.

Mineral (physical) or chemical sunscreen for melasma?

Mineral sunscreens, also called physical, use zinc oxide, titanium dioxide or both; chemical sunscreens use other filters. All of them form a layer on the skin that absorbs the sun's rays, and mineral filters also reflect some. Dermatologists suggest mineral sunscreens for sensitive skin, which they tend to irritate less, and that matters with melasma, where irritation can leave skin darker.

For visible light, the word to look for is “tinted” rather than “mineral”: it is the iron oxides in a tint that block it. A tinted mineral sunscreen covers both.

Sunscreen for pigmentation and melasma on the face: oily, acne-prone, dry or sensitive skin

• Oily skin: a gel or a light fluid. Gels suit oily skin and hairy areas.
• Acne-prone skin: one labelled oil-free or non-comedogenic, made not to block pores.
• Dry skin: a cream, which suits dry skin and the face.
• Sensitive skin: mineral and fragrance-free.
• Men: the same choices, worked into the beard line and onto the ears and neck; a gel spreads more easily through a beard.

Make-up or a moisturiser with SPF helps, but it counts as your sunscreen only if you wear as much of it as you would of sunscreen and reapply it every two hours.

How to use sunscreen for melasma: how much, how often, and what gets missed

• About a teaspoon for the face, enough to cover the length of your index and middle fingers, and more for the neck and ears.
• About 15 minutes before you go out, then again at least every two hours outdoors and straight after swimming or sweating.
• Every day of the year, cloudy days and car journeys included.
• Right up to the edge of the upper lip, where melasma can sit, with a lip balm of SPF 30 or more on the lips themselves.
• A wide-brimmed hat, UV-blocking sunglasses and shade for the rest, and outdoor time planned away from the hours around midday.
• No sunbeds or sunlamps: they can worsen melasma and stop treatment from working.

Can sunscreen reduce pigmentation on its own?

It protects more than it removes. Sunscreen stops new light from darkening melasma and lets other treatment work, which is why doctors count protection from UV and visible light among the first-line treatments for melasma, alongside creams prescribed to lighten it, which a doctor chooses and follows up. Melasma linked to a pregnancy or the pill may lighten by itself after the birth or after stopping it, but it can also last for years.

Sun spots built up over years, and melasma that sits deeper in the skin, usually need treatment as well, and with melasma the protection continues afterwards, because sun, heat and hormonal change tend to bring it back.

Melasma treatment in Dubai: what may help alongside sunscreen

A doctor looks first: at the pattern, at any spot that is new or changing, which is checked medically before anything else, and at what drives your melasma, from pregnancy plans and the pill to medicines that make skin sensitive to light. At CREAMÉ, 350 Al Wasl Road, Jumeirah 1, that is Dr. Svetlana Tagaeva, our Medical Director, or Dr. Olga Ibrakova, a doctor in cosmetology whose work includes Sylfirm X, BBL HEROic and MOXI.

Sylfirm X, radiofrequency microneedling, is usually the doctor's choice for melasma, because it delivers its energy beneath the surface rather than aiming at pigment from above. A course is usually three to five sessions about four weeks apart, with the fuller result at eight to twelve weeks. In a small study in women with melasma, three sessions improved it and the improvement held at six months, though about one in ten saw it return within four months. Pinkness for a day or two is usual; darker patches afterwards are uncommon but possible, especially with sun.

BBL HEROic, broadband light, and MOXI, a gentle laser, suit sun spots better and are used for melasma only carefully and on the doctor's judgment, because heat and light can provoke it as easily as clear it. Heleo4 LED is planned with care, or waits, while melasma is active, since blue light can darken medium and deeper skin. All of these wait during pregnancy and breastfeeding.

Living with melasma through the Dubai year

The cooler months, roughly October to April, make it easier to avoid strong sun and heat, so they suit a course; treatment can still go ahead in summer with strict sun protection and no tanning around each session. Pigment tends to creep back over a summer, which is what a maintenance session or two a year is for.

Heat is worth planning around too: saunas, steam and hot yoga stay away from the days around each session. In pregnancy, when melasma is common, treatment waits and sun protection carries the plan; ask your doctor before using any lightening cream, and the doctor reassesses once you have finished breastfeeding.