Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study

Abstract

Introduction Melasma is a common acquired disorder of hyperpigmentation and has a significant effect on quality of life. The aim of this prospective cross-sectional study was to assess the effect of melasma on depression, social anxiety and self-esteem in the Greek population. Methods The study included a total of 254 participants: 127 patients with melasma and an equal sample of healthy controls. Both participant groups completed the following psychometric measures: the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and Rosenberg’s Self-esteem Scale (RSES) for self-esteem. Furthermore, in patients with melasma, quality of life was assessed using Melasma Quality of Life (MELASQoL). Results Melasma patients (7.47 ± 4.53) presented statistically significantly higher anxiety compared to healthy controls (6.06 ± 3.59, p = 0.006), while no differences emerged with regard to depression or self-esteem. It is important to note that the difference regarding anxiety remained significant ( b = 1.25, p = 0.003) even after adjusting for age, depression and self-esteem. A higher disease severity (MASI) correlated statistically significantly with longer disease duration ( r = 0.24, p < 0.001), higher depression ( r = 0.28, p = 0.002), and a more impaired health-related quality of life (MelasQol; r = 0.29, p < 0.001). Notably, a more impaired health-related quality of life was also correlated with higher depression ( r = 0.19, p = 0.027) and lower self-esteem ( r = − 0.31, p < 0.001). Conclusion The results of this study highlight the importance of evaluating quality of life, anxiety and depression in patients with melasma. The therapeutic approach should not be based solely on clinical findings; it should also include an evaluation of the patient’s psychological aspects. Dermatologists can further improve their patient care by being supportive or requesting psychological intervention when needed, resulting in better compliance with treatment and an improved social and psychological status.

Photobiomodulation for melasma treatment: Integrative review and state of the art

“…In this sense, the development of melasma is influenced by various factors such as UV radiation exposure, hormonal stimulation, genetic predisposition, oxidative stress, and others. 5,6 Exposure to UV radiation is a well-known trigger for melasma, as it can induce oxidative stress and promote melanocyte hyperactivity. Furthermore, the involvement of inflammatory mediators, such as cytokines and growth factors, has been implicated in melasma pathogenesis.…”

“…4,5 Based on recent data, in Germany, melasma is more common in individuals with intermediate skin phototypes (III, IV, and V), and the female-to-male ratio of melasma cases is approximately 5.12. 6 In Brazil, melasma is also more prevalent in woman (97.5%), preferentially with skin phototypes II, III, and IV. The age of onset is earlier for phototypes II and III (before 30 years old).…”

“…The visible nature of melasma lesions, particularly on the face, may result in feelings of embarrassment, frustration, and self-consciousness. 6,7 The psychosocial implications can extend to various domains, including interpersonal relationships, professional life, and overall well-being. Therefore, the development and implementation of effective treatment strategies for melasma are of utmost importance to improve the patients' quality of life.…”

“…Epidemiological studies have revealed significant variations in the prevalence of melasma across different populations: It is more common in Middle Eastern, East Asian, Mediterranean‐African, and South American populations 4,5 . Based on recent data, in Germany, melasma is more common in individuals with intermediate skin phototypes (III, IV, and V), and the female‐to‐male ratio of melasma cases is approximately 5.12 6 . In Brazil, melasma is also more prevalent in woman (97.5%), preferentially with skin phototypes II, III, and IV.…”

“…This impact leads to emotional distress, social withdrawal, and reduced self‐confidence. The visible nature of melasma lesions, particularly on the face, may result in feelings of embarrassment, frustration, and self‐consciousness 6,7 . The psychosocial implications can extend to various domains, including interpersonal relationships, professional life, and overall well‐being.…”