BACKGROUND:
Melasma is one of the most common skin conditions seen in dermatology and skincare clinics. It is a difficult, long-lasting, recurring condition characterized by hyperpigmentation. Its causes are not well understood. Melasma affects people of all races and genders but is more common in women with darker skin tones. As a facial disorder, melasma significantly impacts quality of life due to its disfiguring nature. The study evaluated selected Cassipourea species traditionally used for skin lighting for their safety as potential therapeutic agents.

METHODS:
A multimethod approach was employed. A cross-sectional analytical study was conducted involving 150 patients diagnosed with melasma from three private dermatology clinics in Durban, South Africa. Melasma severity and QoL were measured using the Melasma Area and Severity Index (MASI) and the Melasma Quality of Life Scale (MELASQoL), respectively. In vitro and in vivo studies were performed to evaluate the efficacy and safety of the crude bark extract.

RESULTS:
Predictors of quality of life (QoL) were identified through multivariable analysis and stepwise regression, revealing that MASI score, cheek involvement, education level, and menopausal status were significant factors (p < 0.05). No clinical, haematological, biochemical, or histopathological signs of toxicity were observed, and statistical analyses showed no significant differences between treated and control groups. A new compound, 7-Methoxygeranin A, with antioxidant properties, was identified from Cassipourea malosana. The plants work synergistically, with one having stronger antioxidant effects and the other exhibiting anti-tyrosinase activity.

DISCUSSION:
These findings indicate that C. flanaganii is non-toxic at the tested doses and support further research into its development as a safe, plant-based therapeutic for melasma in people with skin of colour, thereby enhancing quality of life.