Quality of life in patients with acquired dermal macular hyperpigmentation: a systematic review

Acquired dermal macular hyperpigmentation (ADMH) encompasses conditions including lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, Riehl melanosis and pigmented contact dermatitis. This group of cosmetically distressing pigmentary disorders poses a therapeutic challenge, yet to our knowledge, there have been no systematic reviews published that describe their impact on quality of life (QoL). 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 December 2022. Articles were included if they (i) were a primary clinical publication, (ii) reported QoL in patients with ADMH, and (iii) were 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 impaired QoL in patients with ADMH. The currently available literature on this topic indicates 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 patients' QoL. Clinicians must be aware of the significant psychosocial burden associated with ADMH. This impact is often overlooked but should be considered when taking a holistic approach to management. We have conducted a comprehensive systematic review of acquired dermal macular hyperpigmentation (ADMH). We identified that ADMH is probably associated with at least a moderate adverse effect on the quality of life of patients. The impact is comparable with that of vitiligo, and is likely greater than that of melasma. Further, we have found that this impact may increase in line with disease duration.