Development and validation of a health-related quality of life instrument for women with melasma.

BACKGROUND: Melasma can have significant emotional and psychological effects on those affected with the condition. In the past, the impact of melasma on health-related quality of life (HRQoL) has been assessed using general measures of skin disease that equally weigh both the physical and psychosocial distress arising from the presence of a dermatological condition. OBJECTIVES: Our purpose was to develop and validate a disease-specific HRQoL instrument to identify the areas of the patient's life most impaired by melasma as well as the effects of the condition on their level of functioning in correlation with disease severity: the Melasma Quality of Life scale (MELASQOL). PATIENTS AND METHODS: A random sample of 102 women identified by an investigator as having melasma were evaluated by the investigator using the Melasma Area and Severity Index (MASI). The patients were then anonymously surveyed with the SKINDEX-16, the Fear of Negative Evaluation scale, the Dermatology Life Quality Index (DLQI), a skin discoloration evaluation questionnaire, and a measure of perceived life quality difference without melasma. The 10-item MELASQOL scale was devised from the comprehensive HRQoL assessment battery. RESULTS: The psychometric properties of the MELASQOL were comparable with the properties of the DLQI and the SKINDEX-16. The MELASQOL scores were highly correlated with the other HRQoL measures. The discriminatory ability of the MELASQOL is superior to the SKINDEX-16 and the DLQI for melasma. The three life domains most adversely affected by melasma (social life, recreation/leisure and emotional well-being) were highlighted by this instrument. These were the same three areas of life that patients believed would improve the most if they no longer were affected by the disease. CONCLUSIONS: The MELASQOL can be used to evaluate objectively the effect of melasma on a patient's HRQoL. The high correlation with the DLQI, the SKINDEX-16 and the skin discoloration questionnaire suggests that the new scale is a valid instrument, which can be used to monitor the level of impairment individuals suffer due to their melasma. The MELASQOL scores can help guide treatment methods as well as track the improvement of patients' HRQoL.

Implications of a utility model for ultraviolet exposure behavior.

Over the past several decades, the incidence of skin cancer has reached epidemic proportions. Despite numerous efforts to increase public awareness of the risks associated with solar radiation, people continue to sunbathe, use indoor tanning facilities, avoid photoprotective clothing, and fail to use sunscreen. We propose using an economic model, the utility model, to better understand how to reduce tanning behaviors. This model has been widely applied in financial decision-making as well as in analysis of risk-taking behaviors such as smoking. The model takes into account both the current perceived benefits of tanning and the future long-term risks. People tend to discount the future; they tend to weigh current benefits more heavily than future risks. As predicted by the model, past prevention efforts that have focused on long-term benefits gained by sun-protective behavior have been largely ineffective. In the current social environment, we cannot expect tanning reduction measures based solely on health education to be very effective. Only by changing public perceptions of a tan will efforts to decrease ultraviolet exposure behavior likely be successful.