Systematic Review and Meta-Analysis of Treatments on Melasma Area Severity Index and Quality of Life

Background: Melasma is a chronic skin condition resulting from increased melanogenic activity, which induces a significant emotional impact on the patient's quality of life. The efficacy of melasma treatments depends on individual response and on the chosen therapeutic approach, which may include topical skin-lightening agents, oral drugs, and chemical peels. Objectives: We aimed to evaluate the reported efficacy of treatment techniques on melasma control and patients' quality of life through a systematic review and meta-analysis, as well as to investigate a putative relationship between melasma severity and quality of life. Methods: Following PRISMA guidelines, we collected data from PubMed, Scopus, and Embase databases. The eligibility criteria included studies that analyzed the quality of life through the Melasma Quality of Life (MELASQoL) scale from populations of patients suffering from melasma, scored by the Melasma Area Severity Index (MASI). Results: We retrieved 1296 records; those that did not meet the eligibility criteria and duplicates were excluded, resulting in 41 papers that underwent qualitative analysis (information synthesis), from which 23 papers containing 34 studies were included in the meta-analysis. The meta-analysis revealed a decrease in both MASI and MELASQoL scores following oral or topical treatment, as well as the chemical peeling procedure. Spearman correlation test showed a mild positive relationship between MASI and MELASQoL scores. Conclusions: This study provides evidence supporting oral and topical pharmacological treatments, as well as chemical peels, as effective interventions for melasma management. Despite high heterogeneity among studies and methodological limitations, all treatment modalities analyzed improved patients' quality of life.