Clinical and epidemiologic features of melasma: a multicentric cross‐sectional study from India

Abstract

Background Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns.Methods A cross-sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed. ResultsThe study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02 years. Females dominated (85%). Proportion of males was highest in the east (22.2%) and lowest in the south (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P-0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P = 0.003, Mann-Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma.Sunscreens were used by only one-fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%). Conclusion One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma.Sunscreen use seems inadequate in Indian patients; use of steroid-containing medications is more common.

Melatonin and oxidative stress in melasma ‒ an unexplored territory; a prospective study

“…Many studies show different patterns according to regional variation, as noted also in the multicentric study by Sarkar et al, in which 42.8% of patients had a malar pattern of melasma, with the east and west regions of India most commonly and the north and south regions having a majority of combination pattern. Studies conducted by KrupaShankar et al and Achar and Rathi found centrofacial melasma was the most common.…”

Melasma

“…Pigmentation is a downstream result of the process of photoageing, vascular changes and resulting inflammatory mediators. 12 Addressing the hyperpigmentation alone will not yield lasting benefits, hence combination therapy addressing photoageing, light protection and melanin pigment is required.…”

Melasma: A Condition of Asian Skin

“…During pregnancy, in particular, immunologic, endocrine, and metabolic changes make pregnant women vulnerable to changes in the skin [ 21 ]. The mean age of onset is 38 years predominantly in women (85%) and of those, 59.2% reported onset during their second trimester of pregnancy and 34.6% reported onset after pregnancy [ 22 ]. This suggests that female hormone variations may be involved in the initial pathogenesis of melasma.…”

“…The patients were surveyed and their duration of sun exposure per day was approximated. The estimated exposure time was then compared to the severity of the melasma [ 22 ]. The severity of melasma was determined using the Melasma Area and Severity Index (MASI) which is a universal tool that quantifies the severity based on three factors: area of involvement, darkness, and homogeneity [ 3 ].…”

“…A numeric score of 0-6, ranging from 0=no involvement to 6=90-100%, is calculated and assessed. It was concluded that there was a positive statistical difference between the duration of exposure to the melasma severity index (p<0.001) [ 22 ].…”