The Scoring Aid: MASI and Modified MASI

Abstract

There are currently several ways to quantify severity of melasma in patients. Quantitative methods using the Mexameter and chromameter are useful for point measurements of degree of darkness, but these instrumentations suffer from the inability to quantify the extent of melasma. Scoring aids, like the melasma severity scale (MSS), the melasma area and severity index (MASI) and the modified melasma area and severity index (mMASI), were developed to take into account both the darkness and extent of melasma. While these scoring systems are better measures of melasma severity, they are nevertheless fraught with problems as it requires a doctor to estimate the area and degree of darkness and as such results in intra-observer and inter-observer variability. Without a good, reproducible, standardized way of scoring melasma severity and response to treatment accurately, treatment outcomes cannot be standardized and as such, efficacy of various treatment modalities cannot be compared in meta-analyses. Of late, there are several efforts underway to utilize computer image analysis to accurately score melasma, using the principles of the mMASI. These systems seem to offer much promise in standardizing and accurately scoring melasma, enabling treatment options to be compared.