title: A cross-sectional, multicentric clinico-epidemiological study of melasma in India.
abstract: BACKGROUND
  Melasma is one of the most common pigment disorders seen by a dermatologist and often occurs among women with darker complexion (skin type IV-VI).
  
  
  OBJECTIVE
  The present study aimed to investigate the epidemiology of melasma in the Indian population and to focus on the regional variability in the demographics, clinical manifestations and factors that precipitate this condition.
  
  
  METHODS
  The present multicentric study conducted across four regions in India enrolled patients (>18 years) diagnosed with melasma on Wood's light examination. Patients were examined to identify the distribution of melasma. Various precipitating and etiological factors for melasma were documented.
  
  
  RESULTS
  The mean age of the 331 enrolled patients with melasma was 37.2 ± 9.3 years. The prevalence of melasma was higher in females with a female to male ratio of approximately 4:1. The overall population with family history was 31%, highest in the northern region (38.5%) and lowest in the eastern region (18.2%). The two prominent patterns of distribution were centrofacial (42%) and malar (39%). Only 35% of the patients were using sunscreens. Of these, 10% of the patients used sunscreen with SPF >50. The usage of sunscreens was observed to be highest in the north (69%). About 51% of women with multiple pregnancies had a history of melasma when compared with single women (25%) or with no pregnancy (24%).
  
  
  CONCLUSIONS
  In conclusion, the result of the study showed that there was a regional variability in the demographics, clinical manifestations and factors that precipitate melasma among patients in India. There was a strong correlation between the family history and prevalence of melasma. Sun exposure is a major precipitating factor in melasma, but only 10% of the patients used sunscreen with SPF >50. Other factors such as concomitant medication, chronicity of disease, multiple pregnancies and use of oral contraceptives might precipitate melasma.
authors.affiliation: Department of Dermatology, Manipal Hospital, Bangalore, 560017, Karnataka, India, dermakrupa@yahoo.com.
authors.forename: Devasthanam Sundara Rao
authors.initials: DS
authors.lastname: KrupaShankar
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Somani
authors.forename: Malvika
authors.initials: M
authors.lastname: Kohli
authors.forename: Jaishree
authors.initials: J
authors.lastname: Sharad
authors.forename: Anil
authors.initials: A
authors.lastname: Ganjoo
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kandhari
authors.forename: Venkat Ram
authors.initials: VR
authors.lastname: Mysore
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aurangabadkar
authors.forename: Subrata
authors.initials: S
authors.lastname: Malakar
authors.forename: Maya
authors.initials: M
authors.lastname: Vedamurthy
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kadhe
authors.forename: Salman
authors.initials: S
authors.lastname: Motlekar
authors.forename: Pashmina
authors.initials: P
authors.lastname: Ahirrao