dermatology

MASI — Melasma Area and Severity Index

Melasma Area and Severity Index (Kimbrough-Green 1994): area (0–6), darkness (0–4) and homogeneity (0–4) in four facial regions — forehead 30 %, right malar 30 %, left malar 30 %, chin 10 %. Total 0–48. The modified MASI (Pandya 2011) drops homogeneity (0–24). Used in trials to track response.

Forehead (30 %) — area involved*

Forehead (30 %) — darkness*

Forehead (30 %) — homogeneity*

Right malar (30 %) — area involved*

Right malar (30 %) — darkness*

Right malar (30 %) — homogeneity*

Left malar (30 %) — area involved*

Left malar (30 %) — darkness*

Left malar (30 %) — homogeneity*

Chin (10 %) — area involved*

Chin (10 %) — darkness*

Chin (10 %) — homogeneity*

Score interpretation

MASI (0–48) 0–48

Higher scores mean more extensive and darker melasma. There are no validated MASI severity cut-offs — use the score to track change (a falling MASI shows response).

→ Daily broad-spectrum SPF 50+ (mineral preferred); avoid heat / friction; topical Kligman trio (hydroquinone 4% + tretinoin 0.05% + fluocinolone 0.01%) 8 weeks; chemical peels (glycolic acid, mandelic acid). Oral tranexamic acid — Adults: tranexamic acid 250 mg BD (off-label), or oral tranexamic acid 250–500 mg BD for 3 months. Children: use a children's formulary. Refractory melasma: specialist dermatology input; Q-switched / fractionated lasers (use cautiously — risk of post-inflammatory hyperpigmentation). Long-term photoprotection critical to prevent recurrence.

Interpretation bands for the MASI. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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