Psychosocial impact of melasma: Asian Americans and people with pre-existing anxiety disorders are disproportionately affected

Abstract Melasma is a chronic hyperpigmentation disorder that affects sun-exposed skin, particularly the face, and is most common in adult women with darker skin phototypes (Fitzpatrick III-VI). It is notoriously difficult to treat and can adversely impact quality of life This study examined psychosocial associations of melasma in the National Institutes of Health’s All of Us Research Program. Participants ( n = 746) with melasma who completed the “Overall Health” survey were matched with controls on age, sex, race, and income. Duration of melasma, sunlight intensity, treatment history, and pre-existing psychiatric conditions were accounted for in multivariable logistic regression analyses within melasma and between cases and controls. Self-reported Asian Americans with melasma had lower psychosocial health scores compared with both non-Hispanic White Americans with melasma (low mental health odds ratio 4.9 [95% confidence interval 1.9–13], p = 0.002; low ability to complete social roles 3.5 [1.4–9.2], p = 0.01; low social satisfaction 4.7 [2.0–11], p = 0.002) and Asian Americans without melasma (low mental health 4.0 [1.3–13], p = 0.04; low ability to complete social roles 3.5 [1.2–10], p = 0.04; low social satisfaction 3.1 [1.1–8.3], p = 0.04). This association may reflect beauty ideals in Asian American communities, where lighter skin is associated with privilege. Additionally, individuals with melasma and pre-existing anxiety reported poorer mental health than those with anxiety alone (1.4 [1.1–1.8], p = 0.04). Limitations include the retrospective design, reliance on diagnostic codes, and small sample size. These findings suggest that the psychosocial impact of melasma may be magnified in Asian Americans and people with anxiety disorders, identifying a potential need for individualized psychological support.