Overview

Melasma is a common pigmentation disorder causing brown or grey-brown patches primarily on the face. Significantly more common in women with darker skin tones and one of the most-searched skin concerns in the GCC. In Kuwait, intense UV, widespread contraceptive use, and pregnancy make it especially prevalent.

Symptoms

• Flat brown or grey-brown patches on the face; symmetrical pattern on both sides
• Worsens in summer, fades slightly in winter
• No itching or pain — primarily a cosmetic concern
• May also appear on the neck and forearms

Causes & Risk Factors

• UV exposure — the most powerful trigger; critical in Kuwait
• Hormonal changes: pregnancy (mask of pregnancy), oral contraceptives, HRT
• Thyroid dysfunction; photosensitising cosmetics; family history

Complications

• Significant psychological distress and reduced self-esteem
• Treatment resistance in deep dermal melasma
• Recurrence — ongoing sun protection is always required

Diagnosis

Clinical diagnosis based on pigmentation pattern. Wood's lamp determines epidermal vs dermal depth to guide treatment. Biopsy rarely needed.

Treatment

• SPF 50+ sunscreen daily is the foundation — without it, nothing else works
• Topical: hydroquinone 4% (gold standard), azelaic acid, tranexamic acid, niacinamide, vitamin C
• Oral tranexamic acid for recalcitrant melasma
• Chemical peels (glycolic/lactic acid); laser used cautiously on darker skin

Prevention

• Apply SPF 50+ every morning, even on cloudy days and indoors near windows
• Wear wide-brimmed hats; avoid 10am-4pm sun in Kuwait; reapply every 2 hours outdoors
• Discuss contraceptive alternatives with your gynaecologist if melasma appeared with hormonal contraception

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