The Melismatic Misery

Dear Editor, Pigmentary disorders refer to changes in skin color due to a decrease or increase in pigment. They include melasma, vitiligo, and freckles. Among these, melasma is the predominant pigment disorder found in the Indian realm. Melasma is a common disorder of acquired hyperpigmentation characterized by tan or brown macules and patches localized to photo-exposed areas of the face. In melasma, symmetric, irregular brown patches of hyperpigmentation over photo-exposed areas are seen more commonly in females, although involvement in males is observed in 10% of cases.[1] Melasma is caused by a variety of factors such as ultraviolet rays, hormonal therapy, genetic predisposition, pregnancy, thyroid dysfunction, cosmetics, medications containing phototoxic agents, and women with Fitzpatrick III–VI skin.[2] Studies have established that people attending dermatology clinics for pigmentation issues have a greater preponderance of psychiatric disorders than the general population. Research studies have revealed that there was high psychiatric comorbidity in patients with melasma, and most of the patients suffered from depressive disorders. In many cultures, clear and even skin is associated with beauty and youth. These societal expectations can exacerbate the psychological impact of melasma. As melasma typically appears on the face, it can significantly alter an individual’s perception of their appearance. This can lead to feelings of self-consciousness, embarrassment, and a diminished sense of self-worth. Melasma can erode professional confidence, leading to reluctance to take on leadership roles, participate in presentations, or network effectively. This can hinder career advancement and create a sense of professional stagnation. Working women often balance many responsibilities, and adding the emotional burden of melasma can lead to a significant increase in stress. This stress can exacerbate the condition itself, creating a vicious cycle. Patients with melasma stay away from getting clicked, and avoid social gatherings due to fear of judgment. They start getting disconnected from society because of the stigma of good looks that we have today. Melasma causes psychological impact such as anxiety, depression, low self-esteem, and poor body image.[3] Significantly higher Hospital Anxiety and Depression scale scores were found in melasma patients than in the comparable control group. Many cases of melasma are often seen in psychodermatology clinics, considering the fact of the recurrence and strong emotional impact, anxiety, and depression in chronic cases, melasma will only be fitting to classify it as a psychocutaneous disorders.[4] Currently, treatment for melasma remains challenging. However, topical kojic acid, azelaic acid, tranexamic acid, A mixture of hydroquinone, tretinoin, and dexamethasone (Kilgman’s formula), chemical peels, and laser treatment can also be effective. The management of melasma is exigent because it’s a chronic condition with common recurrence. This recurrence triggers emotional trauma in the affected patients. Many chronic melasma patients are emotionally vulnerable and distressed due to the feeling of hopelessness that develops in them that they can never be cured of their condition. Depressive disorders are more common in patients suffering melasma for more than 2 years.[5] Dermatologists should recognize the psychological impact of melasma and provide comprehensive care that addresses both the physical and emotional aspects of the condition. Cognitive–behavioral therapy can be particularly helpful in addressing negative thoughts and behaviors. Its crucial to acknowledge that melasma is more than just a cosmetic concern. Its psychological impact can significantly affect an individual’s well-being, and therefore, a holistic approach to treatment is essential. The effect of melasma on the quality of life cannot be assessed only based on the severity of the disease, as patient characteristics have a significant impact on the quality of life as well. Since the impact is mainly reflected through their mental health, an objective assessment that pays close attention to the needs of patients and psychological comfort is required. Through psycho-neuro-endocrine pathways, melasma, or darkening of skin over sun-exposed areas, has a bidirectional cause-and-effect link with depression and stress. Therefore, it is high time melasma gets recognized as a psycho-cutaneous disorder due to its attribution to psychiatric ailments prevailing during and after the disorder. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.