|Year : 2016 | Volume
| Issue : 2 | Page : 63-65
Melasma and MELASQOL: Using the Hindi MELASQOL in Indian patients
Shilpa Garg1, Rashmi Sarkar MD, MNAMS 2
1 Department of Dermatology and Cosmetology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
2 Department of Dermatology, Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||27-Dec-2016|
Professor, Department of Dermatology, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Garg S, Sarkar R. Melasma and MELASQOL: Using the Hindi MELASQOL in Indian patients. Pigment Int 2016;3:63-5
Quality of life includes factors which impact an individual’s life. Health-related quality of life (HRQOL) measures physical, social, and psychological well-being of an individual and evaluates the burden of disease on daily life. Melasma affects the HRQOL due to its location on the face and disfiguring skin discoloration. It undermines the physical, emotional, psychological, and social well-being of those affected. Tools to measure HRQOL are general health questionnaires, dermatology-specific questionnaires, and disease-specific questionnaires.
Dermatology Life Quality Index (DLQI) is a dermatology-specific questionnaire. In the study titled “A clinical study of melasma and assessment of DLQI at a tertiary health care center in South India,” the authors have used DLQI to evaluate the quality of life in those patients affected by melasma. This quality of life assessment contains 10 items [Table 1]. The response of the patient is graded on a four-point scale ranging from “very much” to “not at all” against all the 10 items. The score of each item is added to give a total score ranging from “0” which represents “no effect” to “30” which represents “highest impairment to quality of life.” The advantages of using DLQI as a tool to measure the impact of melasma in patients are that it is a dermatology-specific questionnaire and it provides a holistic approach in the management of patients with melasma, as it covers various aspects of an individual’s life such as their feelings, symptoms, daily activity, work, leisure, personal relationships, and treatment. However, the shortcomings of this tool for assessing impact of melasma is that this questionnaire is not especially designed for melasma and incorporates certain questions which may not be entirely relevant for melasma such as how itchy, sore, painful, or stinging has your skin been (i.e., the physical symptoms), interference in going shopping or looking after home or garden and preventing to do work or studying (items 1, 3, and 7 of [Table 1]). It lacks the sensitivity for measuring the effect that a pigmentary disorder like melasma has on quality of life. The DLQI gives equal weight to physical and psychological distress caused by the skin diseases. Since melasma affects the psychosocial well-being far greater than the physical well-being, DLQI does not serve as a specific scale for melasma. In addition, DLQI is in English language. Since majority of the patients in India may not be conversant with good understanding of English language, it limits the application of this tool in our country.
Melasma Quality of Life Scale (MELASQOL) is a disease-specific questionnaire which was devised by Balkrishnan et al. in the year 2003. This questionnaire specifically emphasizes the quality of life issues which are specific to melasma. It evaluates 10 items which focus more on the emotional and psychosocial aspects of melasma rather than the physical symptoms. In this questionnaire, seven items are from the Skindex-16 and three items are from a skin discoloration questionnaire. These 10 chosen items showed the highest correlation with both the Skindex-16 and the skin discoloration questionnaire. Each item is scored using a Likert scale ranging between 1 (not bothered at all) and 7 (bothered all the time). The MELASQOL score ranges from 7 to 70, with a higher score indicating worse quality of life.
This instrument which was first compiled in English language by Balkrishnan et al. has now been translated and validated in various languages, including Hindi, Spanish, French, Brazilian Portuguese, Persian, and Turkish. Sarkar et al. translated and validated this questionnaire in Hindi [Table 2]. The Hindi MELASQOL, being in Hindi language, is of practical importance to us as most of our patients are more conversant with reading and understanding Hindi language as compared to English. The high mean MELASQOL score in multiple studies conducted across various regions in different languages [Table 3] show that melasma has significant impact on the quality of life.,,,,,, Melasma affects various domains of quality of life like social life, recreation and leisure, emotional well-being, money matters, physical health, and family relationships.
A specific questionnaire for melasma like MELASQOL is important as studies have shown that severity of melasma clinically assessed by Melasma Area Severity Index may not correlate with the quality of life in those affected.,, This implies that the therapeutic decisions should not be entirely based on clinical severity assessed by the treating physician but must also incorporate the psychological impact that the disease has on the patient.
The concept of assessing the burden of disease has moved from only incorporating the physician’s assessment of the severity of disease mostly based on its physical impact on the patient to now incorporating the psychosocial hindrance that the disease has on the patient. Since melasma is present on the face, it affects the social and psychological well-being of the patient more than the physical well-being. Therefore, it is very important for the treating physicians to have a specific tool to assess the quality of life in patients with melasma which will help in evaluating and treating the patient more holistically. Since MELASQOL is a disease-specific dermatologically relevant HRQOL questionnaire for melasma which focuses on its effects on the psyche of the patient and which is validated and translated in various languages all across the globe, we recommend it over DLQI for assessment of this disease. Furthermore, since its translation is already available in Hindi language, it becomes all the more practical to execute in our population as compared to DLQI which is available in English language.
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[Table 1], [Table 2], [Table 3]