Understanding Melasma: Lifeworld Reflective Approach
Ali Tariq Abd Al Hussan 1
1 Medical College, Karbala University, Iraq.
Objective: Adopting new attitude toward patients with skin diseases taken into consideration their lifeworld which enable understanding and effective communication. Second aim is to evaluate the impact of Melasma on patient lifeworld and quality of life in a sample of Iraqi women. Methods: This study was conducted at my private clinic in the period between April 20114 and March 2015. DLQI is administered & all women answered questions on a 0-3 scale based on their experience during the previous 7 days. The scores are then tabulated and expressed as a number from 0 to 30 or, alternatively, as a percentage of the maximum score, with higher values indicative of poorer outcomes. A maximum score of 30 means that the quality of life of the sufferer is greatly affected. A descriptive analysis of the score was performed. In addition we use interpretative phenomenology (lifeworld approach) which is a qualitative research method that describes the meaning of a lived experience from the perspective of the patient. Phenomenology seeks to achieve a deep understanding of the phenomenon being studied through a rigorous, systematic examination of it from inside perspective. Its aim is to describe the essences of lived experiences. Results: Seventy patients with melasma were participated in this study; 49(70%) married and 21 (30%) unmarried with an age range from 18 to 48 years and the mean ± SD (30.1 ± 6.3) & 78.6% of women were under 35. They were mostly married (70%) & about 81.42 had suffered from melasma for 4 years, and 18.57% for more than 5 years. The mean ± SD DLQI score was (12.52 ± 6.44) (median: 13) .Women under 35 years of age had a higher score than those over 35 years of age (12.77 vs. 5.2). Also the score is higher in unmarried women than married (19.24 vs. 9.53). Mean MASI score was 9.15.which is not correlated with DLQI score. Mean disease duration was 2.98. We found that QOL in Iraqi patients (both on DQL questionnaire & interpretive phenomenology methods) was significantly affected, the burden higher in unmarried compared to married women. Presence of melasma was associated with higher DLQI scores, indicating worse life quality. Conclusion: the study revealed that melasma has a deleterious impact on the HRQOL. It severely affects patient lifeworld and consequently their well‐being, and socioeconomic effect through continuous seeking for whitening drugs that give them false hope.