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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 154-156

A clinico-epidemiological study of melasma in 402 patients in an office-based practice


Skin, Cosmetic and ENT Care Center, Bengaluru, Karnataka, India

Date of Web Publication15-Jul-2019

Correspondence Address:
D A Satish
#742, Bhagyashree, 37th F Cross, 18th Main, Next to Cafe Coffee Day, Jayanagar 4th T Block, Bengaluru - 560 041, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_39_18

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How to cite this article:
Satish D A, Aparna A D, Radhika V K. A clinico-epidemiological study of melasma in 402 patients in an office-based practice. Clin Dermatol Rev 2019;3:154-6

How to cite this URL:
Satish D A, Aparna A D, Radhika V K. A clinico-epidemiological study of melasma in 402 patients in an office-based practice. Clin Dermatol Rev [serial online] 2019 [cited 2019 Aug 23];3:154-6. Available from: http://www.cdriadvlkn.org/text.asp?2019/3/2/154/262779



Sir,

A clinic-based, cross-sectional, descriptive study of melasma was conducted at our center, Skin, Cosmetic, and ENT Care Center, Bengaluru, from April 2015 to December 2017. We included all melasma patients diagnosed by clinical examination and their informed consent was taken. The parameters obtained included age, gender, age of onset of melasma, site of onset, family history, menstrual history, and associated conditions such as hypothyroidism, drug exposure, and pregnancy. The type of melasma (malar, centrofacial, and mandibular) was determined by clinical examination alone and no tools such as Dermoscopy or Wood's lamp were used. Sun exposure was objectively graded; patients with a history of exposure to the sun for 1 h or more per day were considered as statistically significant.

A total of 402 patients with melasma accounting for 40% of facial hypermelanoses attending the clinic during the study period of 2 years 8 months between the age group of 20–80 years were evaluated. They included 325 women and 77 men. The most common age of presentation was the third and fourth decades constituting 131 patients (32.58%) and 149 patients (37.06%), respectively. The mean age of melasma patients in our study was 40.8 years similar to Jagannathan et al.[1] which showed 40.53 years and Singapore study[2] which showed 42.3 years but Qazi et al.[3] which showed 30.1 years.

The age of onset of melasma was significantly higher in the age group of 20–29 years in males (36.36%) and 40–49 years in females (35.07%); the earliest age of onset was 17 years and the latest 80. Maximum patients (69.65%) presented with melasma in the age group of 30–50 years, whereas Kumar et al.[4] showed maximum number of patients (64%) in 20–39 years age group.

Among 402 patients of melasma, 325 (80.8%) patients were female and rest were male (77, 19.15%). The female-to-male ratio was 4.2:1. Females are more prone to develop melasma as shown in Achar et al.[5] and KrupaShankar et al.,[6] with a female-to-male ratio of 4:1. Kumar et al.[4] had a higher female-to-male ratio of 6.4:1 [Figure 1].
Figure 1: A 35-year-old female with melasma in malar region

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Family history and sun exposure were the significant precipitating factors noted in our study. Family history of melasma constituted 41.7% of our patients among which 35.06% were males and 43.38% were females. Although positive family history was more in women when compared to men, our study shows that a higher percentage of family history in males in comparison to other studies. Achar et al.[5] showed 33.33% with a family history of melasma. About 55% female patients presenting early (i.e., between 20 and 30 years of age) had a family history of melasma similar to a study done in Brazilian women.[7] Significant sun exposure was seen in 157 (39.05%) of the patients among which females constituted about 34.15% when compared to men who constituted 59.7%. KrupaShankar et al.[6] showed significant sun exposure in 70% and 100% in the study of patients in Pune.[8] The Singapore study[2] gave history of sun exposure in 26.8% patients.

Of 325 female patients with melasma, 49 (15.07%) had onset of melasma during pregnancy. In six patients, melasma started in the lactation period and four patients had spontaneous remission postpregnancy. According to Kumari et al., melasma was seen in 2.5% of pregnant women,[9] while Raj et al. reported that 8.8% of pregnant women had melasma.[10] However, Winton and Lewis have reported an incidence as high as 50% probably attributed to their ethnicity.[11]

A total of 30.46% women were in the menopausal age group out of which 28% had melasma around the time of menopause unveiling the role of hormonal factors in the causation.

Hypothyroidism in association with melasma was seen in 49 patients (12.18%). The prevalence of hypothyroidism in a cross-sectional, multicenter epidemiology study conducted at eight centers in India was 10.95% of the overall study population.[12] However, hypothyroidism in association with melasma was seen in 12.18% of our patients – one of the highest associations among various studies comparable to KrupaShankar et al.,[6] which had 11% [Graph 1].



Malar subtype of melasma was the most common and seen in 265 patients (65.9%) followed by centrofacial type seen in 136 (33.83%) patients. A study done in Pune by Pawar et al.[8] also had malar type of the most common, whereas in the study by Achar and Rathi[5] and Qazi et al.,[3] centrofacial was more common [Figure 2] and [Figure 3].
Figure 2: A 45-year-old female with dark brown type of melasma on cheeks (malar)

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Figure 3: A 40-year-old man with light brown melasma on nose, cheeks, and forehead (centrofacial type)

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The average modified melasma area and severity index (MASI) score was 5.8863. MASI score between 2 and 4 was seen in 109 (27.1%) of patients [Table 1], [Table 2] and [Graph 2].[13]
Table 1: Modified melasma area severity index score

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Table 2: Demographic data

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In conclusion, melasma is the most common facial hypermelanosis seen in practice. Melasma demands concern and treatment due to social and cosmetic reasons. Large clinical data provide a clear picture as to the patterns and associations of melasma. The present study highlights key elements such as familial distribution, hormonal factors, and environmental triggers in a study group of 402 melasma patients in office-based practice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jagannathan M, Sadagopan K, Ekkarakudy J, Anandan H. Clinico-epidemiological study of patients with melasma in a tertiary care hospital – A prospective study. Int J Sci Stud 2017;4:117-20.  Back to cited text no. 1
    
2.
Goh CL, Dlova CN. A retrospective study on the clinical presentation and treatment outcome of melasma in a tertiary dermatological referral centre in Singapore. Singapore Med J 1999;40:455-8.  Back to cited text no. 2
    
3.
Qazi I, Dogra NK, Dogra D. Melasma: A clinical and epidemiological study. Int J Contemp Med Res 2017;4:2087-9.  Back to cited text no. 3
    
4.
Kumar S, Mahajan BB, Kamra N. Melasma in North Indians: A clinical, epidemiological, and etiological study. Pigment Int 2014;1:95-9.  Back to cited text no. 4
  [Full text]  
5.
Achar A, Rathi SK. Melasma: A clinico-epidemiological study of 312 cases. Indian J Dermatol 2011;56:380-2.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
KrupaShankar DS, Somani VK, Kohli M, Sharad J, Ganjoo A, Kandhari S, et al. A cross-sectional, multicentric clinico-epidemiological study of melasma in India. Dermatol Ther (Heidelb) 2014;4:71-81.  Back to cited text no. 6
    
7.
Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol 2013;27:151-6.  Back to cited text no. 7
    
8.
Pawar S, Khatu S, Gokhale N. A clinico-epidemiological study of melasma in Pune patients. Pigment Disord 2015;2:219.  Back to cited text no. 8
    
9.
Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol 2007;73:141.  Back to cited text no. 9
  [Full text]  
10.
Raj S, Khopkar U, Kapasi A, Wadhwa SL. Skin in pregnancy. Indian J Dermatol Venereol Leprol 1992;58:84-8.  Back to cited text no. 10
  [Full text]  
11.
Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol 1982;6:977-98.  Back to cited text no. 11
    
12.
Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab 2011;15:S78-81.  Back to cited text no. 12
    
13.
Rodrigues M, Ayala-Cortés AS, Rodríguez-Arámbula A, Hynan LS, Pandya AG. Interpretability of the modified melasma area and severity index (mMASI). JAMA Dermatol 2016;152:1051-2.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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