Validation of a melasma quality of life questionnaire for Brazilian Portuguese language: the MelasQoL-BP study and improvement of QoL of melasma patients after triple combination therapy T.F. Cestari,* D. Hexsel, M.L. Viegas,à L. Azulay,§ K. Hassun,– A.R.T. Almeida,** V.R.P.A. Re ˆgo,   A.M.D. Mendes,àà J.W.A. Filho§§ and H. Junqueira–– *Department of Dermatology, Federal University of Rio Grande do Sul Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil  Dermatology Clinic Doris Hexsel, Porto Alegre, Brazil àMaria de Lourdes Viegas Dermatology Clinic, Rio de Janeiro, Brazil §Dermatology Center, Santa Casa de Misericordia do Rio de Janeiro, Rio de Janeiro, Brazil –Cosmiatry and Surgery Division of Federal University of Sa ˜o Paulo, Brazil **Hospital do Servidor Pu ´blico Municipal de Sa ˜o Paulo, Sa ˜o Paulo, Brazil   Hospital Universitario Prof. Edgar Santos, Salvador, Brazil ààDermatology Department University of Para State, Para, Belem, Brazil §§Hospital Universitario Walter Cantidio, Federal University of Ceara, Fortaleza, Brazil ––Department of Dermatology, University of Goias, Goiania, Brazil Correspondence Tania F. Cestari. E-mail: tcestari@hcpa.ufrgs.br Accepted for publication 29 September 2006 Key words melasma, melasQoL-BP, melasQoL, quality of life (QoL), triple combination Summary Background Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been suc- cessfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients. Objectives To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone aceto- nide and tretinoin) on the QoL of patients with moderate-to-severe melasma. Methods and Results Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7Æ0% of patients, III 23Æ7%, IV 42Æ7% and V 22Æ7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organiza- tion (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we random- ized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influ- ence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach’s alpha coefficient 0Æ919; P <0Æ001) and good correlation with MASI scores. After treatment, the Ó 2006 The Authors Journal compilation Ó 2006 British Association of Dermatologists • British Journal of Dermatology 2007 156 (suppl. 1), 13–20 13