Psychosocial impact of melasma: Asian Americans and people with pre-existing mood or anxiety disorders are disproportionately affected

Melasma is a chronic hyperpigmentation disorder that primarily affects sun-exposed areas of the skin, especially the face. It is most common in adult women with darker skin phototypes (Fitzpatrick III and IV), and it is notoriously difficult to treat. As a result, melasma can adversely impact mental health and quality of life, with affected individuals having higher rates of depression. This study explored the psychosocial associations of melasma using data from the National Institutes of Health’s All of Us Research Program. A total of 746 participants with a melasma diagnosis who completed the “Overall Health” survey were identified and matched with control participants on age, sex, race, and income. Covariates such as duration of melasma, sunlight intensity, treatment history, and pre-existing psychiatric conditions were accounted for in multivariable logistic regression analyses within melasma and between cases and controls. Results revealed that self-reported Asian Americans with melasma had lower mental and social health scores compared with both non-Hispanic White Americans with melasma and Asian Americans without melasma. This association may partly result from beauty ideals in Asian American communities, where lighter skin is regarded as a symbol of privilege. Additionally, individuals with melasma and a pre-existing mood or anxiety disorder reported poorer mental health than those with only the psychiatric disorder. These findings suggest that the psychosocial impact of melasma may be magnified in Asian Americans and people with mood or anxiety disorders. This study emphasizes the need for psychological support for patients at higher risk of adverse mental health outcomes.