Melasma: measure of the impact on quality of life using the French version of MELASQOL after cross-cultural adaptation.

Melasma has significant emotional and psychological effects. These repercussions can be measured using general measures of skin disease. SKINDEX-16 was used in a pilot study (1) to show a significant impact on health-related quality of life (HRQoL) and a correlation with disease severity measured by MASI (Melasma Area Severity Index) (2). A melasma-specific scale, the Melasma Quality of Life Scale (MELASQOL) (1) is highly correlated with the discoloration questionnaire. The discriminatory abilities of MELASQOL were found to be superior to those of SKINDEX-16 and Dermatology Life Quality Index (DLQI) for melasma. The three life domains most adversely affected by melasma (social life, recreation/ leisure, and emotional well-being) have been highlighted by MELASQOL. We constructed a French version of MELASQOL (MELASQOL-F) following thorough cross-cultural adaptation, then used it to evaluate the impact of melasma in French outpatients with melasma. MATERIAL AND METHODS Cross-cultural adaptation was performed using previously established guidelines (3–6). This involved 5 stages: forward translation, review by expert committee, backward translation, test/retest, comparison with other quality of life scales (DLQI and SF-12), and psychometric validation. Two translators produced independent French-language translations of the English-language MELASQOL questionnaire (electronic appendices: http://adv.medicaljournals.se/ article/abstract/10.2340.00015555-0837/app1–2), which were reviewed by a committee of experts who developed a unique French-language translation and modified some items to make them more pertinent and exploitable. Some changes were made. For example, " melasma " was substituted for " skin condition " because the latter term might be interpreted as meaning another skin disease. Another problem was the meaning of the verb " to feel " , which is difficult to translate into French: it was decided to ask a question about " ressenti " but not " sentiment " or " avis " in French (all these words can be translated as " feeling " in Eng-lish). " Discoloration " was translated as " hyperpigmentation " rather than " décoloration ". Finally, all questions were well understood by the women interviewed. A back-translation (from French to English) was then performed to verify that the original questionnaire could be reinstated without any major modification and without alteration of the original ideas and items. Pre-testing using a probe technique was carried out with 30 female patients with melasma. To determine whether each question was correctly understood, patients were asked to justify their answers and explain what the questions meant in their own words. A question was deemed unreadable if more than …