A Study of Factors Associated With Melasma and Quality of Life in Patients With Melasma: A Case-Control Study

Introduction Melasma is a common condition seen in dermatology clinics and is considered to be a multifactorial disease. We designed the present study to: study the factors associated with melasma (including metabolic syndrome (MetS) and biochemical parameters); compare the characteristics of melasma and other factors (MetS and biochemical parameters) in male and female melasma patients; and evaluate the quality of life in melasma patients and its correlation with the severity of the condition.  Methods This study is a case-control study of 80 individuals with melasma and 80 controls attending a private dermatology clinic in Mumbai, India. We collected demographic details and other risk factors in both groups and clinical details in patients with melasma. We assessed the following biochemical parameters, such as fasting blood sugar, glycated hemoglobin (HbA1c), triglycerides, and high-density lipoproteins. In patients with melasma, severity was evaluated using the Melasma Area and Severity Index (MASI) score, and quality of life using the Melasma Quality of Life (MELASQOL) questionnaire. Results The mean (SD) age of the cases (37.2 (5.9)) was significantly higher than controls (30.6 (7.0)) years (p<0.001). A significantly higher proportion of cases had a family history (in first-degree relatives) compared with controls (52.5% (n=42) vs 16.3% (n=13); p<0.001). A lower proportion of cases were classified as MetS compared with controls; however, it was not statistically significant (30.0% (n=24) vs 33.8% (n=27); p=0.61). Although a higher proportion of females had metabolic syndrome compared with males, the difference was not statistically significant (35.2% (n=19) vs 19.2% (n=5); p=0.15). In multivariate models, melasma was significantly associated with age ≥35 years (odds ratio (OR): 4.3, 95% confidence interval (CI): 1.6, 11.4; p<0.01), being married (OR: 4.8, 95% CI: 1.1, 21.7; p<0.01), and a family history of melasma (OR: 8.1, 95% CI: 2.9, 23.1; p<0.01). Males melasma cases were more likely to have high triglyceride levels compared with females (OR: 8.6, 95% CI: 1.6, 47.5; p=0.014). Correlation between MASI and MELASQOL scores was statistically significant in females (r=0.28; p=0.04), but not in males (r=12; p=0.573). Conclusions Factors associated with melasma were age ≥35 years, a family history of melasma, and being married. There was no significant difference in those classified as metabolic syndrome between these two groups. In melasma cases, in general, there was no significant difference in demographic and clinical characteristics between males and females. However, males had significantly higher levels of triglycerides compared with females. The association between melasma severity and quality of life was significant only in females.