Journal of

---

Background and Aim: Melasma is an acquired symmetrical brown hyperpigmentation of the face or neck. Melasma has been shown to have a significant emotional and psychologic distress on affected patients. Although this pigmentary disorder is more prevalent among women of reproductive age, the effect of melasma on quality of life in this population is unknown. The aim of this study was to evaluate health-related quality of life in patients with melasma attending to dermatology clinics in Kerman city, Iran.

Methods: A cross-sectional study was carried out by clinical examination and questionnaire on 200 patients with melasma. Melasma area and severity index (MASI), Dermatology Life Quality Index (DLQI) and Melasma Quality of Life Scale (MELASQOL) were used to assess melasma severity and quality of life.
Results: There were 200 women with mean age 31.86±6.42 years old (range: 18-55 years). The mean score of DLQI and MELASQOL were 6.90±4.48 and 40.24±14.95, respectively. In 113 (56.5%) patients, melasma had very large effect on their quality of life. There was a significant correlation between the scores of quality of life questionnaires and MASI (P<0.001). In DLQI scale the most frequent impairment was related to emotional well-being and based on MELASQOL questionnaire, embarrassment due to skin appearance had an important impact on quality of life.
Conclusion: This study revealed that physicians must consider the devastating psychosocial impact of pigmentary imperfections in addition to pharmacological and physical treatment.

---

Background and Aim: Quality of life is a broad concept that reflects an individual’s perspective on the level of life satisfaction experienced in a variety of situations including housing, recreation, environmental conditions, health and job. In this way it is a subjective measure that is affected by factors well beyond health status. To evaluate quality of life in patients with common pigmentation disorders such as vitiligo, melasma, and freckles refer to dermatologic clinics of Kashan University of medical sciences during 2010 and 2011.

---

Background and Aim: Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. The goal of this study was to evaluate the efficacy of a cream containing 4% licorice extract with a novel formulation based on solid lipid nanoparticles technology in the treatment of melasma. To the best of our knowledge, it is the first study designed to investigate the efficacy of this novel formulation in the treatment of melasma all over the world.

Methods: In this randomized, double-blind, placebo-controlled clinical trial, 44 women with clinical diagnosis of melasma referred to the Afzalipour hospital dermatology clinic were randomly allocated into two treatment groups of equal size. All the patients were interviewed and examined every four weeks during the trial and their Modified Melasma Area and Severity Index (MMASI) score were evaluated at 4, 8 and 12 weeks. The efficacy of the interventions were classified in four levels: complete response, significant response, partial response and no response.

Results: Forty patients were enrolled in the study. At the end of the study (12 weeks), mean± standard deviation of MMASI score changed from 11.03±2.7 to 1.41±0.6 in the intervention group and from 11.25±2.9 to 2.37±1.2 in the placebo group, respectively (P<0.001).

Conclusion: Licorice extract can be used as a skin-lightening agent with minimal side effect in the treatment of melasma. Nano/micro solid lipid particles are used as carriers with unique properties like size, surface electrical bar. Moreover, a large amount of the drug might be loaded to increase the efficacy and decrease the adverse events.

---

This is a letter to editor criticizing the paper entitled “Efficacy of licorice extract in the treatment of melasma: A randomized, double-blind, placebo-controlled clinical trial”. We discuss some methodological points on external and internal validity of results. The paper suffers from lack of detailed information on sample size and power calculation to make sure generalisability of results to study population. The paper also did not report blinding procedure and placebo details. The results of the paper also suffer from multiplicity (multiple comparisons) and suitability of data analysis approach. It is recommended to apply either repeated measure ANOVA or a mixed model to consider correlation between repeated measure of outcomes and multiplicity problem.

---

Background and Aim: Melasma is a common disease affecting quality of life. Available treatments result in the gradual and partial clearance of melasma, and are accompanied with high risk of recurrence after discontinuing treatment. Tranexamic acid has been successfully evaluated in several studies. In addition, laser has been proposed as an enhanced drug delivery method. This study is designed to evaluate this enhancing effect.

Methods: Twenty-five patients with bilateral epidermal and mixed type melasma were recruited in the study and applied tranexamic 5% gel bilaterally on face two times a day and randomly underwent fractional CO2 laser treatment on one side of the face monthly. They were evaluated before starting treatment and then every 4 weeks by measuring modified melasma area severity index (mMASI) and melanin index by Dermacatch (Colorix, Switzerland). Also, quality of life was measured and compared in a subset of patients with MELAS QoL questionnaire before and after treatment. The results were analyzed by SPSS software version 18 and the results were compared by paired t test. Due to multiple comparisons, p value of 0.0125 was considered significant.

Results: The mMASI and melanin index were not significantly different between two sides in each follow up (P>0.0125). The mMASI and melanin index significantly decreased after treatment with tranexamic acid with or without fractional CO₂ laser (P<0.001 and P<0.001, respectively)

Conclusion: Although tranexamic acid 5% gel is effective in the treatment of melasma, however, our study did not show additive therapeutic effect by adding fractional CO₂ laser to it.