تاثیر بیماری ملاسما در عزت نفس: مطالعه آزمایشی The effect of melasma on self-esteem: A pilot study

Introduction Background Melasma is a common disorder of hyperpigmentation characterized by tan or brown macules and patches that mainly affect sunexposed areas. Melasma can affect men and women of all ethnicities and skin types but is especially prevalent in women with Fitzpatrick skin types III to V who are exposed to ultraviolet (UV) light (Sheth and Pandya, 2011). Although there are many reports of melasma in Hispanic and Asian individuals, the disorder can affect any racial/ethnic group (Sheth and Pandya, 2011). The precise cause of melasma is unknown but factors such as UV light exposure, pregnancy, exogenous hormones, and genetics have been shown to have an important role in the pathogenesis of melasma (Lieu and Pandya, 2012; Sheth and Pandya, 2011). Melasma is notoriously difficult to treat and has a high rate of recurrence. Although asymptomatic, melasma is a disfiguring disease that negatively affects the quality of life (QoL) and self-esteem of affected individuals. Disfiguring diseases such as melasma take a significant toll on the psychosocial well-being of affected individuals; however, very little has been published on how to improve their QoL and self-esteem. Multiple studies have assessed the QoL of patients with melasma using measures such as the Melasma Quality of Life (MelasQoL) score but few have studied focus groups of patients to ascertain self-esteem and psychological stressors that are associated with the condition (Balkrishnan et al., 2003). We interviewed six patients diagnosed with melasma about the effect of their skin condition on QoL and self-esteem before and after treatment. Quality of life assessments Several different questionnaires have been used to assess the QoL of patients who are affected with melasma. In the 1990s, questionnaires such as the Skindex-16 (Chren et al., 1996, 2001) and Dermatology Life Quality Index (DLQI; Finlay and Khan, 1994) specific to dermatologic diseases but not disease-specific were used to measure the psychological effects of melasma on patients. Subsequently, in 2003, a disease-specific QoL questionnaire, MelasQoL, was developed for patients with melasma (Balkrishnan et al., 2003). The MelasQoL has been shown to be more specific than the Skindex-16 and DLQI and has been translated and validated into multiple languages (e.g., Spanish, Portuguese, French, Turkish, Iranian, Turkish, Hindi; Aghaei et al., 2005; Balkrishnan et al., 2003; Dogramaci et al., 2009; Dominguez et al., 2006; Misery et al., 2010; Sarkar et al., 2016). The findings of the various studies in different languages are listed in Table 1. Contradictory findings with regard to the correlation between the QoL of patients and the severity of their melasma as measured by the melasma area and severity index indicate the effect of melasma on QoL is not solely dependent on disease severity but is multifactorial. Treatment may also affect QoL. In two studies (Dominguez et al., 2006; Misery et al., 2010),