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Paudel S, Acharya Poudel I, Upadhyay P, Kumar Shah M, Pokharel S, Sharma R. Quality of life in Nepalese Patients with Melasma: An Observational Cross-Sectional Study at a Tertiary Center. J Nepal Health Res Counc 2022; 20:316-320. [PMID: 36550706 DOI: 10.33314/jnhrc.v20i02.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Melasma is an acquired pigmentation disorder of the sun exposed parts of the body, particularly face. It is a significant cosmetic concern for the young adults, which is the most frequently affected age-group. Finding the level of impairment in quality of life in melasma patients and correlating with the severity. METHODS All consenting patients with melasma visiting our out-patient from December 2020 to June 2021 were enrolled. Clinical evaluation was done by the same single reviewer in all cases using modified Melasma Area and Severity Index. Dermatology Life Quality Index (Nepali version) was asked to complete to the patient. Data were collected and analyzed. Frequency and mean were calculated for all variables, comparison of means by Mann-Whitney U test and correlation analyses by Spearman's correlation test were performed. RESULTS Females were 82.5%(99) of total cases. Among these 70.8%(85) were married, 68.3%(82) had family history of melasma and 65%(78) had centro-facial phenotype. Mean Dermatology Life Quality Index score was 10.25±0.54. Mean score of females was higher than that of males. The daily activities sub-domain was the worst affected with 50.67% of impairment. Females suffered significantly more than males in symptom and feeling sub-domain. Modified Melasma Area and Severity Index was significantly higher in males (7.12±.56 Vs. 5.66±.28). The severity and duration of melasma did not correlate to the quality of life. CONCLUSIONS Melasma had a moderately negative impact in the quality of life of the patients. Females suffered more due to melasma. The clinical severity of melasma did not correlate with the quality of life impairment. Thus, psychological assessment to all the melasma patients seem to be an important aspect of management.
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Affiliation(s)
- Sushil Paudel
- Department of Dermatology, Civil Service Hospital, Kathmandu, Nepal
| | | | - Priti Upadhyay
- Department of Dermatology, Civil Service Hospital, Kathmandu, Nepal
| | | | - Shruti Pokharel
- Department of Dermatology, Civil Service Hospital, Kathmandu, Nepal
| | - Rabindra Sharma
- Department of Dermatology, Civil Service Hospital, Kathmandu, Nepal
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Zhu Y, Zeng X, Ying J, Cai Y, Qiu Y, Xiang W. Evaluating the quality of life among melasma patients using the MELASQoL scale: A systematic review and meta-analysis. PLoS One 2022; 17:e0262833. [PMID: 35085327 PMCID: PMC8794204 DOI: 10.1371/journal.pone.0262833] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background According to the literature, pigmentary disorders have a significantly negative impact on a person’s health-related quality of life. Moreover, among pigmentary disorders, incidence of melasma ranks high. The Melasma Area and Severity Index (MASI) is the scale that is generally used to evaluate a melasma-affected area and its severity. However, the relationship between the MASI and Melasma Quality of Life (MELASQoL) scores, as well as the impact of melasma on patients’ quality of life, remain unclear. Objectives To explore the influence of melasma on patients’ lives, analyze the relationship between the MASI and MELASQoL scores, and identify the factors that may be influencing the quality of life of patients with melasma. Methods Two reviewers independently searched four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for literature on quality of life of patients with melasma. In addition to an epidemiological study, a cross-sectional study, and validation studies, gray literature was also included. StataSE version 16 software was used for the meta-analysis. The score of each item on the MELASQoL scale was determined using a random-effects model. Results Fourteen studies with a total of 1398 melasma patients were included in the systematic review, four of which were eligible for meta-analysis. The relationship between the MELASQoL and MASI scores was found to be mixed. Five studies concluded that the MASI and MELASQoL scores were statistically correlated, while seven studies found no statistical correlation between the two. It is obvious that melasma causes emotional distress and has a negative impact on patients’ social lives. Patients were most bothered by the appearance of their skin condition. However, the MELASQoL score had no definite correlation with patient characteristics such as age, education levels, and history. Conclusion Melasma has a significant negative impact on patients’ quality of life. Thus, evaluating the quality of life of patients with melasma should not be ignored. Additionally, utilization of the MELASQoL scale should be considered in the care plan. Further studies with larger sample sizes are needed to confirm the relationship between melasma and quality of life.
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Affiliation(s)
- Yuan Zhu
- Department of Dermatology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaofang Zeng
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jieya Ying
- Department of Dermatology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujia Cai
- Department of Dermatology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu Qiu
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wenzhong Xiang
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, China
- * E-mail:
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Abstract
Melasma is a chronic dermatologic condition with an incompletely understood pathogenesis and well-demonstrated impact on patient quality of life. Melasma is a common cause for seeking dermatologic care, and with no universally efficacious therapy or cure, com-bination treatment is the best approach for many cases. Numerous studies have demonstrated the role of oxidative stress in patients with melasma, prompting investigation into several antioxidants for melasma therapy. In this review, we discuss the well-defined role of oxidative stress in melasma and the therapeutic efficacy of various antioxidants for patients suffering from melasma. We focus our discussion on studies investigating the role of vitamin C, azelaic acid, cysteamine, glutathione, carotenoids, and numerous other antioxidants in disorders of hyperpigmentation. There is promising evidence for the use of these antioxidants, as topical, oral, and intra-venous preparations, both in isolation and in conjunction with other melasma therapies. J Drugs Dermatol. 2020;19(8):788-792. doi:10.36849/JDD.2020.5079.
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Abstract
Post-inflammatory hyperpigmentation (PIH) is a reactive process resulting from increased melanin or abnormal distribution of melanin secondary to inflammatory skin conditions, dermatologic therapies, and external stimuli. Because PIH is a common condition that has a substantial effect on the quality of life, an understanding of its treatment modalities is essential. Though there are many therapeutic strategies for hyperpigmentary conditions such as melasma that are described in the literature, fewer studies focus on PIH. This article aims to provide a comprehensive literature review of therapies specifically used to treat PIH, such as topical combinations, chemical peels, and lasers. J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.4887.
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Abstract
Melasma is a commonly acquired condition that mostly affects women with Fitzpatrick skin types III-VI with prominent brown pigmentation with or without an underlying erythema. Despite multiple treatment options, melasma can be challenging given its chronic and relapsing nature. The objective of this article is to review the quality of life impact of melasma and offer suggestions for enhancing the melasma specific quality of life scale.
J Drugs Dermatol. 2020;19(2)184-187. doi:10.36849/JDD.2020.4663
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Kaufman BP, Alexis AF. Randomized, Double-Blinded, Split-Face Study Comparing the Efficacy and Tolerability of Two Topical Products for Melasma. J Drugs Dermatol 2020; 19:822-827. [PMID: 33026755 DOI: 10.36849/jdd.2020.10.36849/jdd.2020.5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Melasma is a common disorder of hyperpigmentation that disproportionately affects individuals with skin of color. There is a paucity of studies evaluating non-hydroquinone (HQ) topical therapies for the treatment of melasma in darker skin types. OBJECTIVE To compare the safety, efficacy, and tolerability of a HQ-free, retinol-free cosmetic topical brightener (CTB) and HQ 4% in the treatment of moderate symmetric facial melasma in patients with Fitzpatrick skin types (FST) III–VI. Methods & Materials: This was a randomized, double-blinded, split-face clinical trial. Eighteen adult patients with facial melasma were treated with CTB and HQ 4%, each to a different side of the face, twice daily for 12 weeks. Clinical assessments included half-face Melasma Area Severity Index (MASI), Overall Hyperpigmentation scale, and Melasma Severity Rating Scale (MSRS). Patients completed a Melasma Quality of Life (MelasQoL) questionnaire and clinical photographs were taken at each visit. RESULTS CTB and HQ 4% demonstrated statistically significant improvements in half-face MASI, Overall Hyperpigmentation, MSRS and MelasQol compared to baseline. HQ 4% showed statistically significant improvements in MSRS at week 12 compared to CTB, but was non-superior for all other clinical endpoints. CONCLUSION HQ-free, retinol-free CTB and HQ 4% both are effective and well-tolerated in the treatment of moderate facial melasma in FST III–VI. J Drugs Dermatol. 2020;19(9):822-827. doi:10.36849/JDD.2020.5353.
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Amatya B, Pokhrel DB. Assessment and Comparison of Quality of Life in Patients with Melasma and Vitiligo. Kathmandu Univ Med J (KUMJ) 2019; 17:114-118. [PMID: 32632057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Melasma is an acquired hyperpigmentary condition that is characterized by development of irregular brown to black macules occurring predominantly on the face. Vitiligo is an acquired depigmenting skin disease characterized by progressive loss of inherited skin colour, which leads to appearance of white patches. Both the conditions occur more frequently in people with racially pigmented skin resulting in psychological morbidities and impacting the quality of life. Objective To evaluate and compare the quality of life in patients suffering from melasma or vitiligo, which represent two opposite ends of pigmentary disorders using the Dermatology Life Quality Index (DLQI). Method This was a hospital based cross sectional study that was conducted at the Department of Dermatology and Venereology, Tribhuwan University Teaching Hospital from September 2016 to August 2017. The study population included adult patients of either sex with melasma or vitiligo, who consented to participate in the study. Result There were a total of 100 patients each in both melasma and vitiligo groups. While females outnumbered their male counterparts by a ratio of 9:1 in melasma, the gender distribution was more equal in vitiligo. Melasma had a mean DLQI score of 5.64 ± 5.41 and a median score of 4 while vitiligo had a mean DLQI score of 4.13 ± 3.74 and a median score of 3. Conclusion Melasma patients had a higher impairment in quality of life compared to vitiligo patients. The quality of life in both the conditions varied based on age, gender, duration and distribution.
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Affiliation(s)
- B Amatya
- Department of Dermatology and Venereology, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu
| | - D B Pokhrel
- Department of Dermatology and Venereology, Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu
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Pollo CF, Miot LDB, Meneguin S, Miot HA. Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQ-melasma). An Bras Dermatol 2018; 93:391-396. [PMID: 29924234 PMCID: PMC6001090 DOI: 10.1590/abd1806-4841.20186780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/19/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. OBJECTIVE To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. METHODS Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. RESULTS The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). STUDY LIMITATIONS Single-center study. CONCLUSIONS A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.
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Affiliation(s)
- Camila Fernandes Pollo
- Department of Nursing, Faculdade de Medicina de Botucatu -
Universidade Estadual Paulista (FMB-Unesp), Botucatu (SP), Brazil
| | - Luciane Donida Bartoli Miot
- Department of Dermatology, Faculdade de Medicina de Botucatu -
Universidade Estadual Paulista (FMB-Unesp), Botucatu (SP), Brazil
| | - Silmara Meneguin
- Department of Nursing, Faculdade de Medicina de Botucatu -
Universidade Estadual Paulista (FMB-Unesp), Botucatu (SP), Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Faculdade de Medicina de Botucatu -
Universidade Estadual Paulista (FMB-Unesp), Botucatu (SP), Brazil
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Abstract
The aim of this study was to analyze scientific production concerning the validation and cultural adaptation of quality of life evaluation instruments for patients with melasma and to offer a critical reflection on these methods. A literature review was performed based on a search of the Web of Science, Bireme, PubMed, Elsevier Scopus, and Google Scholar databases. All published articles from indexed periodicals in these electronic databases up to December 2015 were included. Eight articles were identified, of which only one (12.5%) referred to the development and validation of a specific instrument for evaluation of the quality of life of melasma patients. An additional six articles (75%) referred to transcultural adjustment and validation of the same instrument in other languages, and another (12.5%) article reported the development of a generic instrument for evaluation of quality of life in patients with pigment disorders. This review revealed only one specific instrument developed and validated in different cultures. Despite being widely used, this instrument did not follow the classic construction steps for psychometric instruments, which paves the way for future studies to develop novel instruments.
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Affiliation(s)
- Camila Fernandes Pollo
- Enfermagem, Campus de Botucatu, Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, BR
| | - Silmara Meneguin
- Enfermagem, Campus de Botucatu, Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, BR
- *Corresponding author. E-mail:
| | - Helio Amante Miot
- Departamento de Dermatologia e Radioterapia, Faculdade de Medicina, Universidade Paulista Julio de Mesquita Filho, Botucatu, SP, BR
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Krengel S, Breuninger H, Beckwith M, Etchevers HC. Meeting report from the 2011 International Expert Meeting on Large Congenital Melanocytic Nevi and Neurocutaneous Melanocytosis, Tübingen. Pigment Cell Melanoma Res 2011; 24:E1-6. [PMID: 21672181 DOI: 10.1111/j.1755-148x.2011.00875.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Misery L, Schmitt AM, Boussetta S, Rahhali N, Taieb C. Melasma: measure of the impact on quality of life using the French version of MELASQOL after cross-cultural adaptation. Acta Derm Venereol 2010; 90:331-2. [PMID: 20526570 DOI: 10.2340/00015555-0837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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. [PMID: 18410339 DOI: 10.1111/j.1468-3083.2007.02472.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Melasma can cause a significant effect on individual emotional well-being. Melasma Quality of Life Scale (MELASQoL) is a specific questionnaire elaborated to assess the burden of melasma on patient's quality of life. OBJECTIVE To evaluate the clinical aspects, severity and the influence of melasma on daily living of a sample of Brazilian women. METHODS Cross-sectional study that enrolled 85 women with melasma older than 15 years of age. Trained investigators asked 55 questions to collect epidemiological and clinical data. The disease severity was clinically assessed using Melasma Area and Severity Index (MASI). Patients answered the Portuguese version of 10-item MELASQoL scale without coaching. RESULTS The mean +/- SD age was 41.1 +/- 6.8 years, and the mean +/- SD of MELASQoL score was 37.5 +/- 15.2 (median, 35). Patients with previous psychiatric diagnosis had significantly higher MELASQoL scores (mean, 42.8; SD, 13.6) than patients without this antecedent (mean, 35.4; SD, 15.4; P < 0.05). Patients with less than 8 years of school attendance also had significantly higher MELASQoL score (mean, 44; SD, 16.9) than more graduated ones (mean, 34.4; SD, 13.5; P < 0.05). The mean +/- SD MASI was 10.6 +/- 6.6 (median, 10.2). There was no correlation between MASI and MELASQoL. CONCLUSIONS This study confirms that MELASQoL-BP is easy to administer, adds important information about the impact of melasma on South American women's life and, finally, contributes to building evidence on the validity, reliability and cultural adaptation of the Portuguese language MELASQoL version.
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Cestari TF, Hexsel D, Viegas ML, Azulay L, Hassun K, Almeida ART, Rêgo VRPA, Mendes AMD, Filho JWA, Junqueira H. 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 Suppl 1:13-20. [PMID: 17176300 DOI: 10.1111/j.1365-2133.2006.07591.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients. OBJECTIVES To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate-to-severe melasma. METHODS AND RESULTS Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7.0% of patients, III 23.7%, IV 42.7% and V 22.7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach's alpha coefficient 0.919; P < 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (P = 0.814; chi-square), skin colour (P = 0.449; probability ratio) or skin pigmentation (P = 0.814; chi-square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; P < 0.001) after treatment, with the mean +/- SD results shifting from 44.4 +/- 14.9 at baseline to 24.3 +/- 15.5 after treatment. The analysis of the MelasQoL-BP before and after treatment showed an important effect of the impact of treatment on a number of QoL measures. Of note, skin appearance (69.8 vs. 10.1% of patients were bothered all the time or most of the time, respectively), frustration (59.7% vs. 12.2%, respectively), embarrassment (56% vs. 9.3%, respectively) and influence of the disease on interpersonal relationships (35.3% vs. 5.8%, respectively) were greatly improved. CONCLUSIONS This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate the quality of life and response to melasma treatment in Brazilian patients. The triple combination treatment produced significant results, regarding both clinical severity and quality of life.
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Affiliation(s)
- T F Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
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Abstract
Neurocutaneous syndromes are disorders characterized by a neurological abnormality and cutaneous manifestations. Three of the more common neurocutaneous syndromes are Sturge-Weber syndrome, tuberous sclerosis, and neurofibromatosis. This review focuses on the cognitive and behavioral features of these syndromes.
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Affiliation(s)
- Charles M Zaroff
- Comprehensive Epilepsy Center, New York University, 403 East 34th Street, New York, NY 10016, USA.
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Rendon MI. Utilizing combination therapy to optimize melasma outcomes. J Drugs Dermatol 2004; 3:S27-34. [PMID: 15552597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Melasma is a chronic and recurrent disorder. It has been underdiagnosed and undertreated due to lack of effective therapies and the perception that it is merely a cosmetic nuisance. Hydroquinone, corticosteroids, licorice extracts and kojic acid have been used as monotherapy to treat melasma. However, the present standard of care in melasma therapy is combination therapy. To date, the most effective treatment is a triple-combination agent that contains hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01%. In clinical trials, its use led to complete or near-complete clearing of melasma in 8 weeks. A long-term study demonstrated its continuing efficacy and safety for as long as 360 days. In an examination of quality of life parameters, patients using the triple-combination cream showed significant improvements in self-perception by all 1290 patients. Various combinations of melasma therapy, such as chemical peels, particularly as adjuvants to the triple-combination cream, are discussed.
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Affiliation(s)
- Marta I Rendon
- Dermatology & Aesthetics Center, Boca Raton, FL 33486, USA.
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de Andrade DO, Dravet C, Raybaud C, Broglin D, Laguitton V, Girard N. An unusual case of neurocutaneous melanosis. Epileptic Disord 2004; 6:145-52. [PMID: 15504713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 04/10/2004] [Indexed: 05/01/2023]
Abstract
The neurocutaneous melanosis (NCM) is a rare, neuroectodermal dysplasia defined by the association of giant or multiple, nonmalignant pigmented cutaneous nevi with leptomeningeal melanosis or melanoma. As a rule, the cerebral pathological substratum is characterized by a melanocytic infiltration of the leptomeninges, often leading to hydrocephalus. The most frequent clinical symptomatology starts early in life, with convulsive seizures, psychomotor delay, intracranial hyperpression: the prognosis is severe. Malignant melanomas can also occur. One 21 years-old patient affected by NCM with a giant bathing nevus and epilepsy is reported. Her psychomotor development was slightly delayed. Academic progress was disturbed by the frequency of seizures and the multiple dermatological surgeries, and she remained at the elementary school level. Her epilepsy appeared at seven years and became pharmacoresistant. It was a focal, left temporal epilepsy. Neuroimaging investigations were performed repeatedly, and demonstrated the progressive appearance of parenchymal lesions with T1 and T2 shortening, without contrast enhancement, at the pons (11 years), the two hippocampi (14 years), and of an atrophy of the cerebellum and the brainstem (19 years). No hydrocephalus, tumoral aspect, or meningeal involvement were demonstrated. This patient's case is peculiar because her neurological symptomatology consists only of focal epilepsy, unrelated to a tumor, with moderate cognitive impairment despite a rather long course of the disease. Her evolution raises the question of condidency to surgical treatment.
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Balkrishnan R, Kelly AP, McMichael A, Torok H. Improved quality of life with effective treatment of facial melasma: the pigment trial. J Drugs Dermatol 2004; 3:377-81. [PMID: 15303781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Melasma is a common hyperpigmentation of the face or neck that can have severe adverse psychological and emotional effects on affected individuals. Although a variety of treatments have been used over the years, results have typically been less than satisfactory. An open-label, community-based trial was undertaken at 393 centers in the United States, enrolling 1290 patients representing a broad range of races/ethnicities and all Fitzpatrick skin types, to evaluate the efficacy and safety of a new melasma treatment that combines fluocinolone acetonide 0.01%, hydroquinone 4.0%, and tretinoin 0.05% (FA+HQ+RA) in a hydrophilic cream formulation. An additional objective of the study was to assess the impact of this therapy on the quality of life. Efficacy and safety were evaluated at 4 and 8 weeks, and changes in a variety of quality of life parameters were analyzed at the conclusion of the study. All measures of efficacy showed that FA+HQ+RA significantly (p<0.0001) improved melasma at 4 weeks with further improvement at 8 weeks across all races/ethnicities and Fitzpatrick skin types. The treatment was safe and well tolerated. After 8 weeks of therapy, patients reported that FA+HQ+RA had provided a variety of benefits that had enhanced their quality of life.
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Affiliation(s)
- R Balkrishnan
- University of Texas Schools of Public Health and Medicine, Houston, Texas 77030, USA.
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Balkrishnan R, McMichael AJ, Camacho FT, Saltzberg F, Housman TS, Grummer S, Feldman SR, Chren MM. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol 2003; 149:572-7. [PMID: 14510991 DOI: 10.1046/j.1365-2133.2003.05419.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Melasma can have significant emotional and psychological effects on those affected with the condition. In the past, the impact of melasma on health-related quality of life (HRQoL) has been assessed using general measures of skin disease that equally weigh both the physical and psychosocial distress arising from the presence of a dermatological condition. OBJECTIVES Our purpose was to develop and validate a disease-specific HRQoL instrument to identify the areas of the patient's life most impaired by melasma as well as the effects of the condition on their level of functioning in correlation with disease severity: the Melasma Quality of Life scale (MELASQOL). PATIENTS AND METHODS A random sample of 102 women identified by an investigator as having melasma were evaluated by the investigator using the Melasma Area and Severity Index (MASI). The patients were then anonymously surveyed with the SKINDEX-16, the Fear of Negative Evaluation scale, the Dermatology Life Quality Index (DLQI), a skin discoloration evaluation questionnaire, and a measure of perceived life quality difference without melasma. The 10-item MELASQOL scale was devised from the comprehensive HRQoL assessment battery. RESULTS The psychometric properties of the MELASQOL were comparable with the properties of the DLQI and the SKINDEX-16. The MELASQOL scores were highly correlated with the other HRQoL measures. The discriminatory ability of the MELASQOL is superior to the SKINDEX-16 and the DLQI for melasma. The three life domains most adversely affected by melasma (social life, recreation/leisure and emotional well-being) were highlighted by this instrument. These were the same three areas of life that patients believed would improve the most if they no longer were affected by the disease. CONCLUSIONS The MELASQOL can be used to evaluate objectively the effect of melasma on a patient's HRQoL. The high correlation with the DLQI, the SKINDEX-16 and the skin discoloration questionnaire suggests that the new scale is a valid instrument, which can be used to monitor the level of impairment individuals suffer due to their melasma. The MELASQOL scores can help guide treatment methods as well as track the improvement of patients' HRQoL.
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Affiliation(s)
- R Balkrishnan
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, NC 27014, USA.
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Abstract
The paper describes a case of neurocutaneous melanosis (NM), with mental retardation, chronic psychosis, and epilepsy possibly due to a temporal focus. This is the first report of NM associated with a severe and chronic psychosis. It is likely that such an association has not previously been described because of the ominous prognosis of most cases of NM with early involvement of the central nervous system.
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Affiliation(s)
- A Azzoni
- Servizio Psichiatrico di Diagnosi e Cura, Ospedale Santo Spirito in Sassia and Servizio di Dermatologia Ospedale Nuovo Regina Margherita, Rome, Italy
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García Peñas JJ, Ramos Lizana J, Roche Herrero C, Carrascosa Romero C, Pascual Castroviejo I. [Neurocutaneous melanosis associated with partial agenesis of the right parietal lobe]. An Esp Pediatr 1992; 36:239-41. [PMID: 1580440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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AGUILERA MARURI C. [Riehl's melanosis of emotional origin in a female patient with generalized vitiligo]. Bol Cult Inf Cons Gen Col Med Esp 1961; 24:47-52. [PMID: 13681734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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