Factors Associated With Quality of Life and Treatment Practice Among Melasma Patients in Nepal

Melasma is chronic, acquired hypermelanosis that commonly appears on sun-exposed areas of the skin. Although it is asymptomatic, it can significantly affect patients' psychosocial and emotional well-being, ultimately reducing their quality of life. This study aimed to assess the factors associated with quality of life and treatment practices among melasma patients in Nepal.

A hospital-based cross-sectional study was conducted among 174 melasma patients visiting Nepal Skin Hospital, Kathmandu, from March to August 2023. The Melasma Area and Severity Index (MASI) score and the Melasma Quality of Life (MELASQoL) scale were used to evaluate melasma severity and quality of life, respectively. Statistical analyses included descriptive statistics, independent t-tests, one-way ANOVA, and multiple linear regression to identify factors associated with quality of life among women with melasma.

The mean (±SD) MELASQoL score was 51.89. Most participants reported feeling frustrated (81.5%), embarrassed (78.8%), depressed (95.40%), and less productive (83.9%) due to melasma. Female gender, illiteracy, both current and previous OCP use, women with multiple pregnancies, lighter skin Types (III and IV), longer disease duration, and moderate MASI scores were significantly associated with higher MELASQoL values (p < 0.05). Sunscreen (97.7%) was the most prescribed treatment, followed by tranexamic acid (78.7%), hydroquinone (76.4%), antioxidants (71.3%), and chemical peels (69.0%).

Melasma has a significant psychosocial impact on affected individuals in Nepal. Disease severity, use of oral contraceptive pills, number of pregnancies, disease duration, education, and skin type significantly influenced quality of life. The strong association between disease severity and MELASQoL underscores the importance of integrating psychosocial assessment into clinical management. Sunscreen followed by tranexamic acid, hydroquinone, antioxidants, chemical peels, multivitamins, and retinoids was the predominant treatment approaches.