A photonumeric scale for the assessment of atrophic facial photodamage

Summary

Background

Photonumeric scales have consistently shown superiority over descriptive equivalents. They have the advantage of providing a consistent visual frame of reference by minimising variability in perception and subjectivity. A photonumeric scale to assess hypertrophic facial photodamage already exists. However, there is currently no objective measure for atrophic facial photodamage. To address this, we have devised a nine-point photonumeric standardised scale.

Objectives

To design, test and validate a photonumeric scale for the assessment of atrophic facial photodamage against a descriptive scale for the same indication.

Methods

A pool of 393 facial photographs (en face and 45º oblique) from 131 individuals with atrophic facial photodamage was created. Five photographic standards were selected and assigned grades 0 through 8, where 0 is no photodamage and 8 is severe atrophic photodamage, thus making a nine-point scale. Twenty photographs spanning the entire range of values were selected to test the scale. Testing was performed alongside a descriptive equivalent. A panel of 10 dermatologists, 10 non-dermatology clinicians and 14 dermatology scientists marked the two scales; marking was repeated one week later.

Results

There was a significantly greater agreement between the graders using the photonumeric scale than the descriptive scale (kappa values 0.71 and 0.37 with standardised errors of 0.57 and 0.17 respectively) with no significant difference in repeatability between the two methods (p < 0.05).

Conclusions

The study describes a new photonumeric scale for atrophic photodamage. This would be a useful adjunct in both the clinical and research settings.

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