Clinical patterns and epidemiological characteristics of melasma in a tertiary care hospital of Nepal

Background: Melasma is an acquired chronic hypermelanosis of sun-exposed areas which significantly impacts quality of life. There are few epidemiological studies in medical literature concerning the disease, even less in the Nepalese population. Aims: The present study aimed to investigate the epidemiology of melasma in Nepalese patients and to focus on the clinical manifestations and factors that precipitate this condition. Materials and Methods: A semi-structured questionnaire was administered to melasma patients treated at a dermatology clinic between 2015 and 2016. Melasma was classified on Wood’s light examination, and the patients were thoroughly examined. Various precipitating and etiological factors for melasma were also documented. Results: We assessed 138 patients, of whom 25 (18.1%) were males and 113 (81.9%) were females. Most of the patients 63 (45.7%) reported their melasma of less than 1-year duration. The most commonly reported trigger factors were prolonged, intense sun exposure 113 (83.3%), stress 48 (34.8%), pregnancy 42 (30.4%), contraceptive pills 8 (5.8%) and over the counter steroids use in 6 (4.3%) patients. Housewives and the unemployed constituted 63 (45.7%) of patients followed by service holders and business associated in 22 (15.9%) of patients. Family history was seen in 47 (34.1%), and a history of previous treatment sought was seen in 62 (44.9%) patients. The maximum number of respondents 91 (65.9%) had Fitzpatrick type III followed by type IV in 42 (30.4%) patients, and 5 (3.6%) had type V skin photo type. Preferred facial topographies were malar 125 (90.6%), central facial 46 (33.3%), forehead 40 (29.0%), and mandibular 19 (13.8%). The pigmentation on woods lamp showed epidermal in 90 (65.2%) followed by dermal in 29 (21.0%) and mixed in 19 (13.8%) patients. Conclusions: Melasma is more common in females with a strong history of intense sunlight exposure, pregnancy, and stress being the most common provoking factors. A multifactorial etiology has to be sought for in depth for all patients presenting with melasma.