Evaluation of cutaneous photodamage using a photographic scale

Abstract

Clinical assessments of photodamage are based upon a subjective evaluation of characteristic features such as wrinkling and pigmentary change, and are influenced by inter-observer differences in grading criteria. In an effort to standardize the grading of photodamage severity, we have developed a six-point photographic scale in which each of the six grades of overall photodamage severity is depicted by three photographs. The use of three photographs to portray each grade illustrates the diversity and range of manifestations within each grade. This photographic scale was tested by two groups of dermatologists, who used it on two occasions to grade the overall photodamage severity of a single group of female Caucasian subjects. Results indicate high inter-observer agreement, with chance-corrected agreement ranging from 0.44 to 0.63 and from 0.54 to 0.76 on the first and second occasions, respectively. Intra-observer repeatability was high, with chance-corrected agreement ranging from 0.56 to 0.78. Inter- and intra-observer differences were within one category in nearly all cases. Similar grades were assigned by dermatologists with and without experience in treating photodamaged patients. We conclude that application of this scale results in consistent and reproducible clinical evaluations of overall photodamage severity in Caucasian subjects. The scale may be useful in categorizing subjects for epidemiological studies, or in selecting patients for clinical trials.

Ethnic skin types: are there differences in skin structure and function?1

“…Griffiths et al [71] and Larnier et al [72] initially suggested that pigmentary changes occur with greater incidence than skin wrinkling in Asians compared with Caucasians. Skin wrinkling does, however, still occur.…”

Performance of intraclass correlation coefficient (ICC) as a reliability index under various distributions in scale reliability studies

“…Scales that are a combination of phrases and photographs are known as photonumeric scales. In aesthetic studies, some examples of scales are measures for the degree of wrinkling,3, 4, 5, 6, 7, 8 lip fullness,9, 10, 11, 12 sagging,13 photodamage,14 and dyspigmentation,15 and they have been developed and evaluated using reliability indexes. In many aesthetic scale reliability studies, ICC is used to determine consistency, where a higher ICC signifies better consistency 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 16…”

Ablative versus non‐ablative treatment of perioral rhytides. A randomized controlled trial with long‐term blinded clinical evaluations and non‐invasive measurements

“…1 Postoperative evaluations were performed 1, 3, 6, and 12 months after the final treatment. Patient satisfaction with the overall treatment result was assessed on visual analogue scales (VAS, 0 ¼ unsatisfied to 10 ¼ maximum satisfaction) [11]. Photodocumentation was performed before treatment and at each postoperative control.…”