Relevant outcomes

• Improvement in patient satisfaction measures, and quality-of-life assessment measures during the time course of the intervention

• Clearance of lesions evaluated by objective methods (for example melasma area and severity index (MASI) or melasma area and melanin index (MAMI); see Box 41.2) or any other objective semiquantitative measures of disease

• Lightening of pigmentation (evaluated objectively by a colorimeter, for example)

• Adverse effects such as irregular pigmentation or irritation related to the interventions

0 no involvement

Severity of melasma is described by a combination of two factors, darkness (D) and homogeneity (H), each evaluated on a scale of 0 to 4, and is calculated as follows: MASI = 0-3(Df + Hf)Af + 0-3(Dra + HJAm + 0'3(Dml + HJAml + 0-1(Dc + Hc)Ac.

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