|Year : 2020 | Volume
| Issue : 2 | Page : 75-79
Assessment of quality of life of melasma patients as per melasma quality of life scale (MELASQoL)
Priyanka N Dodmani, Ashish R Deshmukh
Department of Dermatology, MGM Medical College and Hospital, Aurangabad, Maharashtra, India
|Date of Submission||22-Jul-2019|
|Date of Decision||06-Dec-2019|
|Date of Acceptance||25-Feb-2020|
|Date of Web Publication||03-Dec-2020|
Dr. Priyanka N Dodmani
Department of Dermatology, MGM Medical College and Hospital, Aurangabad, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Melasma is the most common cause of facial melanoses in Indian population. It most commonly affects women of reproductive age group. Melasma poses a significant impact on social and psychological health. Aim: To study specific aspects of life affected in patients’ life by melasma and study the effect of melasma on their level of functioning using melasma quality of life scale (MELASQoL). Materials and Methods: In a cross-sectional descriptive study of 160 patients of melasma with any severity (assessed by MASI) were included. QoL of the patients was assessed using MELASQoL scale based on three domains of life e.g. emotional, social and recreation-leisure. Results: MELASQoL score was calculated for each patient. As per score, QoL in young, females and married patients were more affected than others. Patients having late onset of the disease and short duration are more affected. We found that half of patients were having moderate score, 46% of patients having mild score and only 4% of patients having severe score. In our study most affected domain of life was emotional well-being. Conclusion: Melasma causes a significant effect on QoL in many aspects of daily life. There is no significant correlation between MASI score and QoL affected. There is a need for patient counseling and development of educational programs and appropriate psychological intervention.
Keywords: MASI, melasma, melasqol, quality of life
|How to cite this article:|
Dodmani PN, Deshmukh AR. Assessment of quality of life of melasma patients as per melasma quality of life scale (MELASQoL). Pigment Int 2020;7:75-9
| Introduction|| |
The term "Melasma" is derived from the Greek word "Melas" Meaning Black and it most commonly affects women of reproductive age.  Female preponderance is seen with the female to male prevalence (6:1). Up to l0% of cases are seen in men.  The exact causes of melasma are unknown, although some triggering factors are described, such as sun exposure, pregnancy, use of oral contraceptives and other steroids, consumption of certain food items, ovarian tumors, intestinal parasitoses, hepatopathies, hormone replacement therapy, use of cosmetics and photosensitizing drugs procedures and inflammatory processes of the skin, and stressful events. ,, OC pills and hormone replacement therapy are the most commonly cited triggering factors.,, Elevations of melanocyte-stimulating hormone (MSH), estrogen and progesterone also lead to development of pigmentation in pregnancy., The use of cosmetics and intake of certain drugs such as anticonvulsants and other photosensitizing substances have also been implicated as risk factors for melasma.,
Melasma cause substantial physical and psychosocial distress. Assessing quality of life (QoL) is important in determining a treatment plan and its efficacy. QOL questionnaires specific for skin diseases such as Disease quality of life (DQLI) have been developed because of their ability to assess a patient with any skin condition but melasma quality of life scale (MELASQoL) was introduced to specifically assess QoL affected by melasma.  MELASQOL scores range from 7 to 70, a higher score signifying worse QOL.
| Materials and methods|| |
In this cross-sectional study, a total of 160 patients aged between 18 to 65 years, attending dermatology OPD of our institute from December 2015 to November 2016 with clinical diagnosis of melasma of any severity were included after taking written consent.
The demographic data was recorded in a preset proforma and history was taken with regard to age of onset, gender, Family history, marital status, education, occupation, duration and previous treatment for the same condition. Severity of melasma was calculated using MASI score and effect of melasma on QOL was assessed by using MELASQOL questionnaire consisting of 10 objective questions using a liker scale of 1 to 10; in which 1 signifies not bothered at all and 7 signifies bothered all time, response of each question is added and a total score of 10 (min) to 70 (max) is given. A higher score, indicating a greater burden of disease. lastly, MASI score and MELASQoL score were compared using Chi-square statistical test.
The melasma quality of life (MELASQoL) scale
The MELASQoL scale assesses by appearance of your skin condition, frustration, embarrassment, depression about your skin, its effects on your interactions with other people. Whether it’s making hard to show affection, making you feel unattractive, less vital or productive and affecting your sense of freedom.
Assessment of effect of melasma on QoL of melasma patients was done by classifying the MELASQoL Score according to severity as follows:
| Results|| |
All 160 patients were divided into five age groups. Maximum number of patients were in the age group 25–34 (79 i.e. 49.4%). As per MELASQoL score, the QoL in young, married, educated, females in the age group 25 to 35 years and housewives are more affected. 70 patients who have not taken previous melasma treatment have moderately affected QoL. Amongst the various aspect of QoL, most affected domain of life was emotional well-being, the next affected area of QoL was recreation and leisure. The least affected domain was social life. the QoL of graduate patients is more affected than others. 38 patients who are graduate have moderately affected QoL.
Among 160 patients, 56% were housewives followed by 38% patients who were into other indoor jobs. 44 housewives have moderately affected QoL. Age of onset in patients of melasma is maximum in the age group 25–34 years, that is 61%. The QoL of patients with late age of onset (45–54 years) is more affected than others. Upto 12 months (i.e 45%) was the most frequent duration of the disease meaning people consulted the doctor at the earliest stage of the disease. The QoL of patients with 0–1 year of duration of disease is more affected. 35 patients in this group have moderately affected QoL.
Out of 160 patients, according to MASI Score 124 patients having mild disease, 35 patients having moderate disease and 1 patient is having severe disease.
As per MELASQoL Scale, 50% patients with mild disease are showing moderately impaired QoL. Patients with moderate disease are showing mild as well as moderate impairment of QoL. While the patient with severe disease is showing mild impairment of QoL.
| Discussion|| |
Melasma is a very common skin disease that manifests as symmetrical macules and patches of hyperpigmentation primarily on the face.,. This chronic and recurrent condition causes a deleterious impact on various domains of patients’ QoL.
A total of 160 patients, diagnosed clinically as melasma, were studied. There were 130 (81%) female and 30 (19%) male patients [Table 1]. Mean age of patients was 33.3 ± 8.044 years. In our study 49% patients are from age group between 25 and 35 years. Since 20 to 30 years is peak age for getting married in our country, this might compel people to report early and seek advice about the disease. It was noticed in our study that the QoL was less affected by melasma in patients of age group 45–55 and 55–65 years, this was similar to Farag et al. and Balakrishnan et al.. In our study patients in age group 25–35 years are having more impaired QoL.
|Table 1 Age, sex, marital status, education and occupation distribution with MELASQoL score|
Click here to view
Our data showed a female preponderance (81%) [Table 1]. Females (130) contributed to a wider scale of proportion than the males (30) and the male to female ratio was 1 :4.3. This preponderance was found to be lower than other South East Asian (Malaysia, 1:6; Indonesia, 1:24; Singapore, 1:21) and South American (Brazil, 1:39) studies. In the present study, the female patients showed a greater impairment of QoL than the male patients, similar findings were noted in the study by Arellano et al. These results indicate that about the melasma, women are more worried, distressed and concerned than men.
In our study, 58% patients have education till graduation [Table 1]. Educated patients are also showing more impaired QoL than others. In studies by Dominguez et al. and Freitag et al. it was found that the severity of melasma and impairment in QoL in lower-educated patients were higher. This is because less-educated patients are more likely to be misinformed about their disease. In our study, majority of the patients are housewives (56%) and QoL of housewives is more impaired [Table 1]. 44 housewives that is 50% of them have moderately affected QoL. Among outdoor workers, only 40% of them are having moderate impairment of QoL.
The mean age of onset was 31 ± 6.9 years [Table 2]. This was similar to the study by Achar and Rathi where the mean age of patients with melasma was 33 to 45 years. The QoL of patients with late age of onset (45–55 years) is more affected than others. Among all patients, upto 12 months (i.e. 45%) was the most frequent duration of the disease [Table 3]. So majority suffered from melasma for duration greater than 6 months, this is consistent with the study conducted by Kalla et al. The QoL of patients with 0–1 year of duration of disease is more affected. 35 patients in this group have moderately affected quality of 1ife.
Most of the patients consulted the doctor for first time and had not been taking any prior treatment [Table 4]. According to severity of melasma, most of the patients had a MASI score of range 5-10 [Table 5]. MASI and MELASQoL scores were compared using Chi-square statistical and found there is no correlation between MASI score and MELASQoL. 50% patients with mild disease are showing moderately impaired QoL. Higher MELSQoL scores were observed irrespective of MASI score indicating that severe facial blemishes of any cause affect the self-perception of individual. Various studies on QoL using MELASQoL showed similar results.,,,Melasma has a significant negative impact on QoL. In this study, majority of the patients with most affected domain of life was emotional well-being. Patients were depressed, frustrated and embarrassed about their skin condition [Table 6]. The next affected area of QoL was recreation and leisure. The least affected domain was social life, which made them to avoid social interactions with close friends, relatives or partner. In addition, melasma didn’t affect one’s ability to work, show affection or rob the sense of freedom. Comparable to our study, emotional well-being was reported to be one of the most adversely affected life domains due to melasma, by Balkrishnan et al.
| Conclusion|| |
From the result summarized in our study, it is clear that melasma causes a significant effect on QOL in many aspects of daily life. This study highlights the fact that since clinical severity of melasma does not proportionately match with its impact on QoL, hence it is imperative to manage patient as a whole considering both clinical as well as emotional aspects. There is need for patient counseling or development of educational programs and appropriate psychological intervention. An instrument such as MELASQoL is very useful to assess the impact of melasma on QoL and even to evaluate the result of treatment with a wider and comprehensive approach.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zanieri F, Assad GB, Campolmi P, Lotti T. Melasma: successful treatment with pidobenzone 4% (K5lipogel). Dermatol Ther 2008;21:S18-19.
Lapeere H, Boone B, Schepper SD. Hypomelanoses and hypermelanoses. In: Wolff K, Goldsmith LA, Katz SI et al.
editors. Fitzpatrick’s Dermatology in General Medicine, 7th
edn. Philadelphia: McGraw-Hill 2008. p. 635.
Adalatkhah H, Amani F. The correlation between melasma, ovarian cysts and androgenic hormones (a case-control study). Res J Biol Sci 2007;2:593-6.
Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA et al.
Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol 2013;27:151-6.
Elling SV, Powell FC. Physiological changes in the skin during pregnancy. Clin Dermatol 1997;15:35-43.
Wolf R, Wolf D, Tamir A, Politi Y. Melasma: a mask of stress. Br J Dermatol 1991;125:192-3.
Wu IB, Lambert C, Lotti TM, Hercogova J, Sintim-Damoa A, Schwartz RA et al.
Melasma. G Ital Dermatol Venereol 2012;147:413-8.
Resnik S. Melasma induced by oral contraceptive drugs. JAMA 1967;199:601-5.
Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P et al.
A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol 2009;23:1254-62.
Martin AG, Leal-Khouri S. Physiologic skin changes associated with pregnancy. Int J Dermatol 1992;31:375-8.
Pathak MA, Fitzpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol 1986;15:894-9.
Duarte I, Campos Lage AC. Frequency of dermatoses associated with cosmetics. Contact Dermatitis 2007;56:211-3.
Fleck MP, Louzada S, Xavier M. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica 2000;34:178-83.
Balkrishnan R, McMichael AJ, Camacho FT. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol 2003;149:572-7.
Farag A, Sabry H, Alam M. Melasma and its impact on health related quality of life (HRQoL) in Egyptian women before and after treatment with a quadruple combination serum (hydroquinone 4%, kojic acid 1%, glycolic acid 6% and ascorbic acid 2%). J Pan Arab League Dermatol 2007;18:17-30.
Nicolaidou E, Antoniou C, Katsambas A. Origin, clinical presentation, and diagnosis of facial hypermelanoses. Dermatol Clin 2007;25:321-6.
Arellano I, León G, Luna C. Quality of life in Mexican patients with melasma. Cosmet Dermatol 2006;5:343-5.
Dominguez AR, Balkrishnan R, Ellzey AR, Pandya AG. Melasma in Latina patients: Cross-cultural adaptation and validation of a quality-of-life questionnaire in Spanish language. J Am Acad Dermatol 2006;55:59-66.
Freitag FM, Cestari TF, Leopoldo LR, Paludo P, Boza JC. Effect of melasma on quality of life in a sample of women living in southern Brazil. J Eur Acad Dermatol Venereol 2008;22:655-62.
Achar A, Rathi SK. Melasma: a clinico-epidemiological study of 312 cases. Indian J Dermatol 2011;56:380-2.
] [Full text]
Kalla G, Anush G, Kachhawa D. Chemical peeling- Glycolic acid versus trichloroacetic acid in melasma. Indian J Dermatol Venereol Leprol 2001;67:82-4.
] [Full text]
Johnston GA, Sviland L, McLelland J. Melasma of the arms associated with hormone replacement therapy. Br J Dermatol 1988;139:932.
Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. Risk factors for facial melasma in women: A case-control study. Br J Dermatol 2014;171:588-94.
Cestari TF, Hexsel D, Viegas ML, Azulay L, Hassun K, Almeida AR et al.
Validation of a melasma quality of life questionnaire for Brazilian Portuguese language: The MelasQoL-BP study and improvement of QoL of melasma patients after triple combination therapy. Br J Dermatol 2006;156:13-20.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]