Epidemiological patterns, aggravating factors and impact of disease on quality of life among individuals with melasma visiting the Dermatology Clinic in the Teaching Hospital Karapitiya

Introduction: Melasma is an acquired facial hypermelanosis which affects the quality of life, due to its occurrence in face. This study was aimed to assess its epidemiological patterns, predisposing factors and impact on quality of life in order to educate people to reduce its burden.

Methods: A clinic based descriptive cross-sectional study was conducted recruiting all individuals with melasma, attended the dermatology clinic for seven months. Both self-reported questionnaire and interviewer-administered data record sheet were used for data collection.

Results: 172 individuals with melasma were included. Females were dominated with 97.7% (n=168) and 52.3% (n=90) were with Fitzpatrick type V skin. Mean age of onset of melasma was 47.2 years and the predominant pattern was malar pattern (58.1%). Most common aggravating factor was sun exposure (44.7%, n=76), followed by, menstrual irregularities (20.5%), hormonal treatment (19.4%), family history (19.8%) and pregnancy (10.4%).

Mean MASI (Melasma Area and Severity Index) score was 12.7, with range of 1.5 to 30.9. It showed statistically significant correlation with family history, duration of sun exposure and the use of facial cosmetics (p<0.05).

Mean Melasma Quality of Life Score (MELASQoL) was 28.86 with most patients reported feeling depressed, but there was no significant correlation between severity (MASI) and quality of life (MELASQoL). (Pearson correlation = 0.548, p>0.05)

65.1% exposed into the sun more than two hours in the midday where sun intensity is in peak, but only 31.4% (n=54) used a sun protection method. Sunscreens were used by only 4.65%, although 50% declared regular application of cosmetics to face.

Conclusion: Comparing with other studies, melasma starts at a higher age in our study population. It causes a significant negative effect on psychosocial aspects of quality of life, although it is not related to the clinical severity, suggesting treatment decision should not be made according to its severity.

Sun exposure was the major aggravating factor identified. Therefore, key element in prevention of melasma involves taking measures to minimize sun exposure in peak hours. Although half of people use cosmetic products to face, sunscreens usage seems inadequate in Sri Lankan people, showing the lack of awareness about sunscreens as a prevention method of photo aggravating dermatoses. Therefore, the gravity for protection from sun, should be a key factor to address from young age in our population.