Quality of Life in Patients with Acquired Dermal Macular Hyperpigmentation: A Systematic Review.

Acquired dermal macular hypergpigmentation (ADMH) encompasses conditions including lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, Riehl's melanosis and pigmented contact dermatitis. This group of cosmetically distressing pigmentary disorders pose a therapeutic challenge, yet there have been no systematic reviews published that describe their quality of life (QOL) impact. An electronic database search of PubMed, EMBASE, PsycINFO and Cochrane library was performed in December 2022, to search for articles published from inception until 15/12/2022. Articles were included if they fulfilled the following criteria: (1) primary clinical publication; (2) reports QOL in patients with ADMH; and (3) available in full-text. Overall, the review highlighted a considerable gap in the literature concerning the impact of ADMH on QOL. Seven studies fulfilling the inclusion criteria were included, with a total of 259 patients. All seven studies reported an impaired QOL in patients with ADMH. The currently available literature on this topic indicate that ADMH has a significant adverse impact on QOL, likely to a greater degree than melasma, and to a similar or lesser degree than vitiligo. Five of seven studies reported the QOL impairment for patients with ADMH based on the Dermatology Life Quality Index (DLQI); these studies consistently found a mean DLQI score reflective of a moderate effect on patient's QOL. Clinicians must be aware of, and should seek to address the significant, yet often overlooked, psychosocial burden associated with ADMH when taking a holistic approach to management.