Finally, while it may be best to distinguish from the QoL scale,
willingness to pay is another important measure of disease
burden that should be considered in future melasma clinical
studies.33 A study conducted in Germany on patients with
rosacea found that 25.7% would pay €100 ($130) for a sustainable
cure, 27.1% would pay €500 ($650), 21.4% would pay up
to €1000 ($1300), and 19% would pay greater than or equal to
€1000 ($1300).33 Since data shows that even a small amount of
melasma may be significantly distressing to a patient, willingness
to pay may be another important tool combined with QOL
and self-esteem assessment used to further assess the importance
of adequately treating these patients.
CONCLUSION
Overall, melasma presents as a unique chronic and often recurring
pigment disorder that mostly commonly affects women of
dark skin types. This condition has a significant impact on QOL
and self-esteem in ways that may not be fully captured by the
2003 MelasQOL assessment tool. Several enhancements to this
assessment tool can be made in order to better serve patients
suffering with this condition.
DISCLOSURES
Dr. Fabi has conducted research studies and consulted for
SkinMedica, Colorscience, Lumenis, and Solta. Dr. Goldman
Goldman has conducted research studies and consulted for
SkinMedica, SkinCeuticals, Isdin, Topix, Cell Research Corporation,
Lumenis, and Solta. Dr. Kahga has no conflicts of interest
to declare.
REFERENCES
1. Grimes PE, Ijaz S, Nashawati R, et al. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol 2019;5:30-36.
2. Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther (Heidelb) 2017;7:305-18.
3. Sarkar R, Ailawadi P, Garg S. Melasma in Men: A review of clinical, etiological, and management issues. J Clin Aesthet Dermatol 2018;11:53-59.
4. Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol 2011;65:689-97.
5. Lutfi RJ, Fridmanis M, Misiunas AL, et al. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab 1985;61:28-31.
6. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol 2014;89:771-82.
7. Zaleski L, Fabi S, Goldman MP. Treatment of melasma and the use of intense pulsed light: a review. J Drugs Dermatol 2012;11:1316-20.
8. Wu DC, Fitzpatrick RE, Goldman MP. Confetti-like sparing: a diagnostic clinical feature of melasma. J Clin Aesthet Dermatol 2016;9:48-57.
9. Freitag FM, Cestari TF, Leopoldo LR, et al. 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.
10. Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell Melanoma Res 2018;31:461-65.
11. Mahmoud BH, Ruvolo E, Hexsel CL, et al. Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol 2010;130:2092- 7.
12. Duteil L, Cardot-Leccia N, Queille-Roussel C, et al. Differences in visible light-induced pigmentation according to wavelengths: a clinical and histological study in comparison with UVB exposure. Pigment Cell Melanoma Res 2014;27:822-6.
13. Werlinger KD, Guevara IL, Gonzalez CM, et al. Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth, Tex. Arch Dermatol 2007;143:424-5.
14. El-Essawi D, Musial JL, Hammad A, et al. A survey of skin disease and skinrelated issues in Arab Americans. J Am Acad Dermatol 2007;56:933-8.
15. Ortonne JP, Arellano I, Berneburg M, 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.
16. Balkrishnan R, McMichael AJ, Camacho FT, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol 2003;149:572-7.
17. Miot HA, Miot LD. Re: Topical 10% zinc sulfate solution for treatment of melasma. Dermatol Surg 2009;35:2050-1.
18. Lakhdar H, Zouhair K, Khadir K, et al. Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. J Eur Acad Dermatol Venereol 2007;21:738-42.
19. Goh CL, Chuah SY, Tien S, et al. Double-blind, placebo-controlled trial to evaluate the effectiveness of polypodium leucotomos extract in the treatment of melasma in Asian skin: a pilot study. J Clin Aesthet Dermatol 2018;11:14-19.
20. Goldman MP, Gold MH, Palm MD, et al. Sequential treatment with triple combination cream and intense pulsed light is more efficacious than sequential treatment with an inactive (control) cream and intense pulsed light in patients with moderate to severe melasma. Dermatol Surg 2011;37:224- 33.
21. Sheth VM, Pandya AG. Melasma: a comprehensive update: part II. J Am Acad Dermatol 2011;65:699-714.
22. Ikino JK, Nunes DH, Silva VP, et al. Melasma and assessment of the quality of life in Brazilian women. An Bras Dermatol 2015;90:196-200.
23. Kagha KC, Blauvelt A, Anderson KL, et al. A boxed warning for inadequate psoriasis treatment. Cutis 2016;98:206-07.
24. Harumi O, Goh CL. The effect of melasma on the quality of life in a sample of women living in Singapore. J Clin Aesthet Dermatol 2016;9:21-4.
25. Pollo CF, Miot LDB, Meneguin S, et al. Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQmelasma). An Bras Dermatol 2018;93:391-96.
26. Lieu TJ, Pandya AG. Melasma quality of life measures. Dermatol Clin 2012;30:269-80, viii.
27. Halder RM, Grimes PE, McLaurin CI, et al. Incidence of common dermatoses in a predominantly black dermatologic practice. Cutis 1983;32:388, 90.
28. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis 2007;80:387-94.
29. Jiang J, Akinseye O, Tovar-Garza A, et al. The effect of melasma on self-esteem: A pilot study. Int J Womens Dermatol 2018;4:38-42.
30. Pollo CF, Meneguin S, Miot HA. Evaluation instruments for quality of life related to melasma: an integrative review. Clinics (Sao Paulo) 2018;73:e65.
31. Dayal S, Sahu P, Dua R. Combination of glycolic acid peel and topical 20% azelaic acid cream in melasma patients: efficacy and improvement in quality of life. J Cosmet Dermatol 2017;16:35-42.
32. Wilson MJV, Jones IT, Bolton J, et al. The safety and efficacy of treatment with a 1,927-nm diode laser with and without topical hydroquinone for facial hyperpigmentation and melasma in darker skin types. Dermatologic Surgery 2018;44:1304–10.
33. Moustafa F, Lewallen RS, Feldman SR. The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol 2014;71:973-80.
34. Balkrishnan R, McMichael AJ, Camacho FT, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol. 2003;149:572-7.
2. Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther (Heidelb) 2017;7:305-18.
3. Sarkar R, Ailawadi P, Garg S. Melasma in Men: A review of clinical, etiological, and management issues. J Clin Aesthet Dermatol 2018;11:53-59.
4. Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol 2011;65:689-97.
5. Lutfi RJ, Fridmanis M, Misiunas AL, et al. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab 1985;61:28-31.
6. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol 2014;89:771-82.
7. Zaleski L, Fabi S, Goldman MP. Treatment of melasma and the use of intense pulsed light: a review. J Drugs Dermatol 2012;11:1316-20.
8. Wu DC, Fitzpatrick RE, Goldman MP. Confetti-like sparing: a diagnostic clinical feature of melasma. J Clin Aesthet Dermatol 2016;9:48-57.
9. Freitag FM, Cestari TF, Leopoldo LR, et al. 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.
10. Passeron T, Picardo M. Melasma, a photoaging disorder. Pigment Cell Melanoma Res 2018;31:461-65.
11. Mahmoud BH, Ruvolo E, Hexsel CL, et al. Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol 2010;130:2092- 7.
12. Duteil L, Cardot-Leccia N, Queille-Roussel C, et al. Differences in visible light-induced pigmentation according to wavelengths: a clinical and histological study in comparison with UVB exposure. Pigment Cell Melanoma Res 2014;27:822-6.
13. Werlinger KD, Guevara IL, Gonzalez CM, et al. Prevalence of self-diagnosed melasma among premenopausal Latino women in Dallas and Fort Worth, Tex. Arch Dermatol 2007;143:424-5.
14. El-Essawi D, Musial JL, Hammad A, et al. A survey of skin disease and skinrelated issues in Arab Americans. J Am Acad Dermatol 2007;56:933-8.
15. Ortonne JP, Arellano I, Berneburg M, 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.
16. Balkrishnan R, McMichael AJ, Camacho FT, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol 2003;149:572-7.
17. Miot HA, Miot LD. Re: Topical 10% zinc sulfate solution for treatment of melasma. Dermatol Surg 2009;35:2050-1.
18. Lakhdar H, Zouhair K, Khadir K, et al. Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. J Eur Acad Dermatol Venereol 2007;21:738-42.
19. Goh CL, Chuah SY, Tien S, et al. Double-blind, placebo-controlled trial to evaluate the effectiveness of polypodium leucotomos extract in the treatment of melasma in Asian skin: a pilot study. J Clin Aesthet Dermatol 2018;11:14-19.
20. Goldman MP, Gold MH, Palm MD, et al. Sequential treatment with triple combination cream and intense pulsed light is more efficacious than sequential treatment with an inactive (control) cream and intense pulsed light in patients with moderate to severe melasma. Dermatol Surg 2011;37:224- 33.
21. Sheth VM, Pandya AG. Melasma: a comprehensive update: part II. J Am Acad Dermatol 2011;65:699-714.
22. Ikino JK, Nunes DH, Silva VP, et al. Melasma and assessment of the quality of life in Brazilian women. An Bras Dermatol 2015;90:196-200.
23. Kagha KC, Blauvelt A, Anderson KL, et al. A boxed warning for inadequate psoriasis treatment. Cutis 2016;98:206-07.
24. Harumi O, Goh CL. The effect of melasma on the quality of life in a sample of women living in Singapore. J Clin Aesthet Dermatol 2016;9:21-4.
25. Pollo CF, Miot LDB, Meneguin S, et al. Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQmelasma). An Bras Dermatol 2018;93:391-96.
26. Lieu TJ, Pandya AG. Melasma quality of life measures. Dermatol Clin 2012;30:269-80, viii.
27. Halder RM, Grimes PE, McLaurin CI, et al. Incidence of common dermatoses in a predominantly black dermatologic practice. Cutis 1983;32:388, 90.
28. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis 2007;80:387-94.
29. Jiang J, Akinseye O, Tovar-Garza A, et al. The effect of melasma on self-esteem: A pilot study. Int J Womens Dermatol 2018;4:38-42.
30. Pollo CF, Meneguin S, Miot HA. Evaluation instruments for quality of life related to melasma: an integrative review. Clinics (Sao Paulo) 2018;73:e65.
31. Dayal S, Sahu P, Dua R. Combination of glycolic acid peel and topical 20% azelaic acid cream in melasma patients: efficacy and improvement in quality of life. J Cosmet Dermatol 2017;16:35-42.
32. Wilson MJV, Jones IT, Bolton J, et al. The safety and efficacy of treatment with a 1,927-nm diode laser with and without topical hydroquinone for facial hyperpigmentation and melasma in darker skin types. Dermatologic Surgery 2018;44:1304–10.
33. Moustafa F, Lewallen RS, Feldman SR. The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol 2014;71:973-80.
34. Balkrishnan R, McMichael AJ, Camacho FT, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol. 2003;149:572-7.
AUTHOR CORRESPONDENCE
Karen Kagha MD karen.kagha@gmail.com
