Evaluation of melasma classification methods based on response to treatment

Introduction: Melasma can be classified as epidermal, dermal, or mixed using clinical measures such as Wood''''''''s lamp and dermoscopy. The Melasma Area Severity Index and the Melasma Quality of Life Scale are additional subjective classification methods. Objectives: To compare noninvasive melasma classification methods according to response to treatment. Methods: Ten women with melasma were treated with 4% hydroquinone + 0.05% tretinoin + 0.01% fluociolone acetate for 90 days. They were evaluated before and after treatment using dermoscopy, Wood''''''''s lamp, and both subjective measures. Results: No significant correlations were found between the Melasma Area Severity Index and dermoscopic classification, Wood''''''''s lamp examination and the Melasma Quality of Life Scale. The average percentage improvement after treatment was 60.6% in the severity index and 41.1% in the quality of life scale. Dermoscopy revealed telangiectasia in most patients (60%), including those without prior treatment. Conclusions: The subjective assessment tools best reflected the patients'''''''' response to treatment. The classification using Wood''''''''s lamp did correlate with improvement measured by the severity index. The use of dermoscopy for classifying melasma requires further research, since the findings were not correlated with the expected response to treatment.

Keywords: HYPERPIGMENTATION, CLASSIFICATION, THERAPEUTICS