Melasma: A Monograph Rashmi Sarkar
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Epidemiology and Global Distribution of MelasmaCHAPTER 1

Nokubonga Khoza,
Ncoza Dlova,
Anisa Mosam
 
INTRODUCTION
The accurate prevalence of melasma worldwide is unknown. This is attributed to the fact that melasma is a cosmetic problem and most patients may choose to consult their dermatologist privately.1 Hence, a low prevalence of melasma is recorded in most public dermatology clinics. Unfortunately, these are not truly representative samples.1,2 The prevalence of melasma remains unchanged in the past 3 years with recent literature stating variability between 1 and 50% depending on whether low or high-risk population.3 According to the American Academy of Dermatology, melasma affects 5–6 million people, mostly women in the United States alone.24
There have been few studies that have randomly sampled the general population (Table 1).4
Although melasma affects all races, it is most prevalent among darker skin phototypes (Fitzpatrick skin III–V) and mainly found in patients of Hispanic, Latin Americans, Asians, Middle Eastern, and Africans descent; these have been the most studied groups (Fig. 1).16
Melasma was noted to be a common cutaneous disorder accounting for 0.25–4% of patients seen in dermatology clinics in South East Asia and was the most common pigment disorder among Indians. In the Hispanic population in Texas, Werlinger et al. noted the prevalence to be 8.8% with previous history of melasma in 4% patients.4,7 In Iraq, melasma is also the most common dermatology problem accounting for 26.6% of Iraqi females. The polarity of melasma towards these ethnic groups is influenced by genetic and environmental factors, i.e. living in the areas of intense ultraviolet light exposure and the fact that physiologically darker skin produces larger amounts of melanin in response to solar radiation.1
Hexsel et al. noted that the occurrence of melasma in lighter skin phototypes, i.e. Fitzpatrick skin type II and III was influenced by the presence of family history in contrast to negative family history in Fitzpatrick's phototype IV and V.8
Table 1   Prevalence of melasma
Author
Location
Percentage of cases with melasma (%)
Sivayathorn
Thailand
33
Sarkar et al.
India
20.5 (in men)
Failmezger
Peru
10.1
Werlinger et al.
United States
8.8
Tomb and Nassar
Lebanon
3.4
Parthasaradhi and Al Gufai
Saudi Arabia
2.88
Hiletework
Ethopia
1.8
2
zoom view
Figure 1: Schematic world map view of reported melasma prevalence and cases.
Melasma affects women more than men and occurs during child bearing age. The influence on age of onset have been thought to be related to a positive family history; first degree family having greater influence than the second degree, and supporting genetic factors in the development of melasma.2 Krupashankar et al. also concluded that there is a strong correlation between family history and the prevalence of melasma amongst Indian population, this was highlighted by the regional variation in demographics and factors that precipitated melasma in three regions within India.9 In the Brazilian population, familial melasma is noted with 50% of patients presenting with melasma having a first degree relative with the disease. In these patients, melasma was associated with long disease duration.2 It was observed that family history of melasma was associated with early age of onset in not only Fitzpatrick's Skin types III to V but also skin type II.2,8
Male melasma is related to excessive ultraviolet light exposure, secondarily to occupational and other lifestyle issues in predisposed individuals. Pichardo et al. looking at melasma in immigrant Latino men (poultry processors and manual workers) noted that the prevalence of melasma in Latino men was 14.5% a bit higher than in women.10 Melasma in these men occurred at a later age of onset 31 years or older. In those whose occupation involved high level of sunlight, presentation occurred at an earlier age.10 Sarkar et al. also noted a prevalence of melasma to be about 20.5% in men in a prospective study in a tertiary care hospital, New Delhi, India.11
The relationship between melasma, pregnancy and hormonal influences in melasma has been documented. Most women with melasma report onset of disease during or after pregnancy or in relation to use of oral contraceptives. Pregnancy induced melasma is associated with early disease.2 Few population-based studies that have looked at melasma have shown a varying prevalence of 10–70% suggesting that other factors like ethnicity and sun exposure are significantly involved.2,5,12
Although melasma is a common and easily diagnosed skin condition, better studies are required to address the worldwide epidemiology and prevalence.3
REFERENCES
  1. Al-Hamdi KI, Hasony HJ, Jareh HL. Melasma in Basrah: A clinical and epidemiological study. MJBU. 2008;26:1–5.
  1. Tamega AA, Miot LD, Bonfietti C, et al. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013;27:151–6.
  1. Ogbechie-Godec OA, Elbuluk N. Melasma: An up-to-date comprehensive review. Dermatol and Ther (Heidelb). 2017;7(3):305–18.
  1. Sheth VM, Pandya AG. Melasma: A comprehensive update: Part I. J Am Acad Dermatol. 2011;65(4):689–97.
  1. Ortonne JP, Arellano I, Berneburg M, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23(11):1254–62.
  1. Achar A, Rathi S. Melasma: A clinico-epidemiological study of 312 cases. Indian J Dermatol. 2011;56(14):380–2.
  1. Werlinger KD, Guevara IL, Gonzalez CM, et al. Prevalence of self-diagnosed melasma among pre-menopausal Latino women in Dallas and Fort Worth, Tex. Arch Dermatol. 2007;143(3):424–5.
  1. Hexsel D, Lacerda DA, Cavalcante AS, et al. Epidemiology of melasma in Brazilian patients: A multicenter study. Int J Dermatol. 2014;53(4):440–4.
  1. Krupashankar DS, Somani VK, Kohli M, et al. A cross-sectional, multicentric clinico-epidemiological study of melasma in India. Dermatol Ther (Heidelb). 2014;4(1):71–81.
  1. Pichardo-Geisinger R, Muñoz-Ali D, Arcury TA, et al. Dermatologist-diagnosed skin diseases among immigrant Latino poultry processors and other manual workers in North Carolina, USA. Int J Dermatol. 2013;52(1):1342–8.
  1. Sarkar R, Puri P, Jain RK, et al. Melasma in men: A clinical, aetiological and histological study. J Eur Acad Dermatol Venereol. 2010;24(7):768–72.
  1. Dlova NC, Mankahla A, Madala N, et al. The spectrum of skin diseases in a black population in Durban, KwaZulu-Natal, South Africa. Int J Dermatol. 2015;54(3):279–85.