Correlation Between Erythrocyte Glutathione Levels and Severity of Melasma

Background: Melasma is a common acquired disorder of hyperpigmentation, characterized classically by the presence of symmetrical, light-to-dark, muddy-brown macules with borders on the face, especially the forehead, cheeks, upper lip, chin, and nose. Knowledge of an increase in free radicals and decreased antioxidants in patients with melasma led to the belief that oxidative stress is involved in the pathogenesis of melasma. Glutathione (GSH) is an antioxidant that can be used as a parameter to assess the antioxidant-free radical activity in the pathogenesis of melasma. Objectives: The study aimed to determine the correlation between erythrocyte glutathione levels and the severity of melasma. Methods: A case series study was done from May to July 2018 in the Outpatient Clinic of Dermatology and Venereology Department, Dr. Mohammad Hoesin General Hospital Palembang. Thirty female patients met the inclusion criteria. The independent variable was the erythrocyte glutathione level, and the dependent variable was the melasma severity. The diagnosis was established based on clinical examinations, and the severity was determined by the modified Melasma Area Severity Index (mMASI) score. The correlation between variables was analyzed using Spearman Rho’s test (P < 0.05). The data analysis was done with SPSS version 20.0 (SPSS, Inc Chicago, Illinois). Results: Thirty female patients were diagnosed with melasma. The mean mMASI score was 8.72 ± 5.14 (2.0 to 16.9). Most of the participants had mild melasma (46.7%). The mild group had the highest mean erythrocyte glutathione level (4.05 ± 0.63 μmol/g) and the lowest mean erythrocyte glutathione level was in the severe group (1.79 ± 0.16 μmol/g). There was a very strong negative correlation between erythrocyte glutathione levels and melasma severity (r = -0.907; P = 0.000). Conclusions: There was a very strong negative correlation between erythrocyte glutathione levels and melasma severity.