Skin hyperpigmentation disorders: associations and impact on health-related quality of life
Buainain de Castro Maymone, Mayra
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Hyperpigmentation is a common dermatological complaint that can have profound effect on appearance and quality of life. Disorders of hyperpigmentation comprise a large group of skin conditions characterized by an increase of melanin production, increase in density of active melanocytes, abnormal melanin distribution, and/or deposition of exogenous pigments. This cross-sectional study was conducted to evaluate the impact hyperpigmentation disorders on health-related quality of life and to better understand patient knowledge, approaches, and experiences. The study was conducted on 298 consenting adult patients with a skin related disorder of hyperpigmentation who sought dermatological care at Boston Medical Center (BMC) or East Boston Neighborhood Health Center (EBNHC) from February of 2015 to March of 2016. Patients were anonymously surveyed in order to collect an assortment of information including demographic characteristics, skin condition, health practices, knowledge base, and health-related quality of life (HRQoL) measured with the Dermatology Life Quality Index (DLQI) (Finlay and Khan 1994) and SDIEQ, a five-item , non-validated, brief health-related quality of life questionnaire (A. Taylor et al. 2008). Disease severity was assessed by Melasma Area Severity Index (MASI), Post Acne Hyperpigmentation Index (PAHPI) and body surface area when appropriate. The mean overall DLQI was 6.56 (SD 5.35). In sub-analysis, the mean DLQI in those diagnosed with post-inflammatory hyperpigmentation was 7.89 (SD 0.61), melasma 6.75 (SD 0.45), and other hyperpigmentation disorders 4.5 (SD 0.55). The disease type and duration were both factors associated with a change in DLQI scores. The factors associated with a higher likelihood of patients’ knowledge of their diagnosis included a higher level of formal education, younger age, longer duration of having the condition, and current use of sunscreen, which were found to have 2.4, 2, 3.7, and 2.4 significantly higher odds of knowing their diagnosis, respectively. This study found that the overall impact of hyperpigmentation on health-related quality of life (HRQoL) was small to moderate; however, about 22% reported a very large affect on quality of life. Patients with post-inflammatory hyperpigmentation (PIH) and melasma have significantly lower quality of life when compared with other hyperpigmentation disorders. MASI had a significantly weak correlation with DLQI and SDIEQ, demonstrating that disease severity does not predict patient perception and impact on quality of life.