Facial Melanosis: A Clinico-Dermoscopic Evaluation and Quality of Life Assessment

Background: Facial melanoses (FM) represent a heterogeneous group of pigmentary disorders characterized by altered facial pigmentation, including melasma, lichen planus pigmentosus (LPP), Riehl’s melanosis, erythema dyschromicum perstans, and others. These conditions constitute a major proportion of dermatology outpatient visits and, despite being largely asymptomatic, exert a substantial negative impact on quality of life (QoL) due to cosmetic disfigurement. The etiology of many forms of FM remains unclear, and studies correlating clinical, dermatoscopic, and QoL parameters are limited. Study design: A prospective observational study. Primary objective: To evaluate the change in QoL in patients with FM after three months of diagnosis-based treatment, using the Dermatology Life Quality Index (DLQI) and Melasma Quality of Life Scale (MELASQoL) scores. Secondary objectives: To describe the clinical profile of patients with FM and to identify the etiological spectrum of the condition in the study population. The study also aimed to assess Wood’s lamp findings and dermoscopic patterns of the lesions and to document histopathological findings in selected cases, correlating them with the clinical and dermoscopic features wherever possible. Materials and methods: A prospective observational study was conducted among 50 patients aged 18-60 years with FM involving more than 50% of the facial surface area, attending a tertiary care hospital. Detailed clinical evaluation, Wood’s lamp examination, and dermatoscopic assessment were performed in all patients. QoL was assessed using the DLQI and MELASQoL at baseline and after three months of treatment. Histopathology was undertaken where clinically indicated. Statistical analysis was performed using SPSS v28 (IBM Corp., Armonk, NY). Results: The mean age of participants was 35.7 years; 38 patients (76%) were female, yielding a female-to-male ratio of 3.16:1. LPP was the most common diagnosis, found in 26 (52%) patients, followed by melasma, found in nine (18%) patients. Dermatoscopy most frequently demonstrated an accentuated reticular pattern in 21 (42%) patients and globular pigmentation in 18 (35%) patients, with gray granules correlating with dermal pigmentation in LPP. The mean DLQI score improved from 7.86±6.64 at baseline to 4.78±6.12 at three months, while the mean MELASQoL score decreased from 36.04±21.03 to 26.36±17.42 (p<0.001 for both). Hypothyroidism was the most common associated comorbidity, observed in five (10%) patients. Limitations: Histopathological confirmation was done in limited cases, and the single-center design with a modest sample size may limit generalizability. Conclusion: FM significantly impairs QoL, particularly among young women. LPP emerged as the predominant cause in our study. Dermatoscopy is a valuable non-invasive tool for assessing pigment depth and guiding management. DLQI and MELASQoL are effective instruments for monitoring therapeutic outcomes. Early diagnosis, appropriate counseling, and multimodal therapy are essential to improve patient well-being.