Photonumeric Scale Research Articles

Validation of a Photonumeric Scale for Evaluation of Telangiectasia in Rosacea.

Telangiectasia is a prominent feature of rosacea leading to a high demand for effective treatment. To ensure consistent clinical and scientific evaluations and assess treatment response accurately, standardized assessment tools are necessary for grading the severity of telangiectasia. However, no validated grading scales for this condition are currently available. To develop and validate a photonumeric scale for assessing the severity of telangiectasia in rosacea patients. The five-point photonumeric Telangiectasia in Rosacea Severity Assessment (TRoSA) scale was developed for the severity of telangiectasia in rosacea. Sixteen experts participated in the validation process, evaluating 50 images of rosacea patients in two rounds. Interrater and intrarater reliability were analyzed using the intraclass correlation coefficient (ICC) and weighted kappa, respectively. Interrater reliability was found to be "almost perfect" in both validation rounds (Round 1: ICC 0.847; Round 2: ICC 0.828). The mean weighted kappa indicated "substantial" intrarater reliability between the two rounds with a weighted kappa of 0.719. A bubble plot of the two rounds illustrated a diagonal order, confirming the consistency of the intrarater agreement. The TRoSA scale demonstrated high interrater and intrarater reliability indicating that it is a consistent and reproducible tool for grading the severity of telangiectasia in rosacea. This scale can standardize clinical assessments, assisting in diagnosis, treatment planning, and evaluation of therapeutic efficacy.

Comparisons between wrinkles and photo-ageing detected and self-reported by the participant or identified by trained assessors reveal insights from Chinese individuals in the Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES) cohort

BackgroundChanges develop on the facial skin as a person ages. Other than chronological time, it has been discovered that gender, ethnicity, air pollution, smoking, nutrition, and sun exposure are notable risk factors that influence the development of skin ageing phenotypes such as wrinkles and photo-ageing. These risk factors can be quantified through epidemiological collection methods. We previously studied wrinkles and photo-ageing in detail using photo-numeric scales. The analysis was performed on the ethnic Chinese skin by three trained assessors. Recent studies have shown that it is possible to use self-reported data to identify skin-related changes including skin colour and skin cancer. In order to investigate the association between risk factors and skin ageing phenotypic outcomes in large-scale epidemiological studies, it would be useful to evaluate whether it is also possible for participants to self-report signs of ageing on their skin.AimWe have previously identified several validated photo-numeric scales for wrinkling and photo-ageing to use on ethnic Chinese skin. Using these scales, our trained assessors grade wrinkling and photo-ageing with moderately high inter-assessor concordance and agreement. The main objective of this study involves letting participants grade self-reported wrinkling and photo-ageing using these same scales. We aim to compare the concordance and agreement between signs of skin ageing by the participant and signs of ageing identified by our assessors.MethodThree trained assessors studied facial photo-ageing on 1081 ethnic Chinese young adults from the Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES) cohort. Self-reported facial photo-ageing data by the same 1081 participants were also collated and the two sets of data are compared.ResultsHere, we found that self-reported signs of photo-ageing are concordant with photo-ageing detected by our assessors. This finding is consistent whether photo-ageing is evaluated through studying wrinkle variations (Spearman’s rank correlation (ρ) value: 0.246–0.329) or through studying dyspigmentation patterns (Spearman’s rank correlation (ρ) value 0.203–0.278). When studying individual wrinkles, both participants and assessors often detect the presence of the same wrinkle (Spearman’s rank correlation (ρ) value 0.249–0.366). A weak-to-fair level of agreement between both participants and assessors (Cohen’s kappa (κ) values: 0.041–0.233) persists and is statistically significant after accounting for agreements due to chance. Both the participant and the assessor are largely consistent in evaluating the extent of photo-ageing (area under curve (AUC) values 0.689–0.769) and in discerning between the presence or absence of a given facial wrinkle (area under curve (AUC) values 0.601–0.856).ConclusionWhen we analyse the overall appearance of the face, our results show that signs of photo-ageing identified by the participant are concordant with signs of photo-ageing identified by our assessors. When we focused our analysis on specific areas of the face, we found that participants were more likely to identify and self-report the same wrinkles that our assessors have also detected. Here, we found that self-reported signs of skin ageing provide a satisfactory approximation to the signs of skin ageing identified by our assessors. The ability to use self-reported signs of skin ageing should also be evaluated on scales beyond the ones discussed in this study. Currently, there are not as many photo-numeric scales for quantifying dyspigmentation patterns as there are for quantifying wrinkle variations. As Chinese skin is known to become dyspigmented more easily with age, more photo-numeric scales need to be developed and properly validated.

Comparisons between Caucasian-validated photo-numeric scales and Korean-validated photo-numeric scales for photo-ageing. Insights from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort.

Photo-ageing is a form of skin ageing which affects the entire face. A photo-aged skin has a diverse variety of wrinkles and dyspigmentation all over the face. Here, we discuss photo-ageing on the Chinese skin evaluated using a photo-numeric scale developed and validated on Caucasian skin (i.e., Caucasian scale) and evaluated using a photo-numeric scale developed and validated on Korean skin (i.e., Korean scale). The Korean scale can be subdivided into two scales that separately address the wrinkling and dyspigmentation constituents of photo-ageing. As there are currently no photo-ageing scales for Chinese skin, the main objective of this study is to adapt existing photo-ageing photo-numeric scales for use on ethnic Chinese skin. Three trained assessors studied facial photo-ageing on 1,081 ethnic Chinese young adults from the Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES) cohort. All assessors are highly internally consistent (Weighted Kappa (κw) values≥0.952). We found that the Caucasian scale and Korean scale give nearly synonymous results for the wrinkling constituent of photo-ageing (R2=0.9386). The two scales are strongly concordant (Spearman's Rank Correlation (ρ) value: 0.62±0.06, p=1.31×10-84). A weak-to-moderate inter-scalar level of agreement (Cohen's Kappa (κ) values: 0.38±0.05, p=8.87×10-53) persists and is statistically significant after accounting for agreements due to chance. When tested on ethnic Chinese skin, both scales detect photo-ageing consistently (Area under curve [AUC] values: 0.76-0.84). Additionally, the Korean scale for the dyspigmentation constituent of photo-ageing is concordant with both the Caucasian scale (R2=0.7888) and the Korean scale for the wrinkling constituent of photo-ageing (R2=0.7734). Our results show that the Caucasian scale is suitable for capturing photo-ageing on Chinese skin, especially wrinkle variations. The Korean dyspigmentation scale supplements the Caucasian scale to capture dyspigmentation patterns on Chinese skin that may be absent on Caucasian skin. Currently, photo-ageing scales for Chinese skin are absent. When developed, these photo-ageing scales must be properly validated for their ability to capture photo-ageing of the entire face.

Comparisons between eyebags, droopy eyelids, and eyebrow positioning identified by photo-numeric scales or identified by written descriptive scales: Insights from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort.

We evaluate skin sagging phenotypes (eyebags, droopy eyelids, low eyebrow positioning) using written descriptive scales and photo-numeric scales. We also study how anti-ageing interventions and digital screen time influence skin sagging. We compare the two phenotype assessment methods with each other. Skin sagging and personal lifestyle data obtained from 2885 ethnic Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort were collated and compared. Significant correlations (p-value<0.001) between written descriptive scales and photo-numeric scales were observed for eyebags (0.25) and eyebrow positioning (0.08). Significant correlations (p-value<0.001) were observed after combining both scales for eyebags (0.38), droopy eyelids (0.30), and eyebrow positioning (0.30). Anti-ageing interventions are associated with delayed progression of eyebags from 18-45 years old, droopy eyelids from 31-45 years old, and eyebrow positioning from 35-40 years old. Significantly lower (p-value<0.02) eyebrow positioning is associated with both <1 and 1-3h of screen time stratified by age. Written descriptive scales provide comparable results to photo-numeric scales. However, validating and adapting photo-numeric scales for different populations identifies phenotypes better. Anti-ageing interventions are beneficial at different age ranges. Screen time is associated with skin sagging in young (18-30 years old) participants.

Novel Validated Five-point Photonumeric Scales for Assessment of Static and Dynamic Forehead Lines.

The objective of this investigation was to create and validate five-point photonumeric scales which assess static and dynamic forehead lines. Two different novel five-point photonumeric scales for the assessment of static and dynamic forehead lines were developed. Moreover, a photoguide was created, including subjects from both sexes, all age groups, and different Fitzpatrick skin types. A total of 11 raters from all over the world were involved in the digital validation, whereas four raters performed a live validation. The Croma Static Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in both the digital and the live setting with inter-rater intraclass correlation coefficients of 0.86 [95% confidence interval (CI): 0.82-0.89] in the first digital rating and 0.82 [95% CI: 0.78-0.86] in the second digital rating. The Croma Dynamic Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in the digital setting with inter-rater intraclass correlation coefficients of 0.83 [95% CI: 0.79-0.86] in the first digital rating and 0.80 [95% CI: 0.75-0.84] in the second rating and almost substantial agreement in the live setting. The Croma Static Forehead Lines-Assessment Scale and the Croma Dynamic Forehead Lines-Assessment Scale have excellent inter and intra-rater agreements to be justifiably used in the clinical and study setting, both digitally and live across ethnic groups.

Creation and Validation of a Photonumeric Scale for Assessment of Infraorbital Hollows.

Validated clinical scales are needed to assess aesthetic improvement of the infraorbital hollows (IOHs) after treatment with dermal fillers. To develop an IOHs scale and establish its reliability and sensitivity for grading subjects in clinical trials or routine practice. The Teoxane IOHs Scale (TIOHS), a 5-grade photonumeric scale, was developed based on real-subject photographs and validated through photographic and live subjects' evaluation. Clinician intra- and inter-rater agreements during the TIOHS validation were excellent. The mean intrarater-weighted Kappa score between the 2 sessions of photographic validation was 0.92, while inter-rater interclass correlation coefficient (ICC) was 0.92 for the combined sessions. The average intrarater-weighted Kappa score and inter-rater ICC for the live validation reached 0.80 and 0.76, respectively. In addition, evaluators identified clinically significant differences between photographs of subjects presenting a 1-grade or 2-grade difference in 82% and 86% of cases, respectively. The intrarater Kappa scores and inter-rater ICCs met their predetermined acceptance criteria of >0.70. The TIOHS is a repeatable and reproducible clinician-reported outcome for health care providers to classify IOHs in clinical trials and routine patient care. A 1-grade difference on the TIOHS can detect a clinically meaningful difference in infraorbital hollowing.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Perioral Region.

The use of validated scales is still considered the gold standard in evaluating the severity of an aesthetic facial condition. The objective of this investigation was to create and validate 5-point photo numeric scales which assess perioral lines and marionette lines. A medical team created two different novel 5-point photonumeric scale for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, while 4 raters performed a live validation. For the Croma Static Perioral Lines-Assessment Scale digital inter-rater ICCs were 0.88 [95% CI: 0.85-0.91] in the first rating and 0.87 [0.83-0.90] in the second rating. The digital intra-rater ICCs were 0.90 [95% CI: 0.87-0.92]. In the live rating, the inter-rater ICCs were 0.89 [95% CI: 0.85-0.93] in the first rating and 0.91 [95% CI: 0.87-0.93] in the second rating with an intra-rater ICC of 0.91 [95% CI: 0.88-0.95]. For the Croma Marionette Lines-Assessment scale the digital rating inter-rater ICCs were 0.85 [95% CI: 0.81-0.89] in the first rating and 0.87 [95% CI: 0.84-0.90] in the second rating with an intra-rater ICC of 0.89 [95% CI: 0.88-0.91]. In the live rating, the inter-rater ICCs were 0.73 [95% CI: 0.54-0.83] in the first rating and 0.79 [95% CI: 0.65-0.87] in the second rating with an intra-rater ICC of 0.88 [95% CI: 0.83-0.94]. It is to be concluded that the Croma Static Perioral Lines-Assessment Scale and the Croma Marionette Lines-Assessment Scale have exceptional inter- and intra-rater agreements to be justifiably used in the clinical and study setting for all ethnic groups.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.

There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.

Development and Validation of a Photonumeric Scale for Evaluation of Lip Fullness.

The shape, proportion, and fullness of one's lips are associated with overall facial beauty and attractiveness. Lip augmentation, due to personal preference or to reverse natural aging, has become a standard clinical procedure to improve lip volume or proportion. Several options are available to redefine the lips. To objectively evaluate treatment-related improvements in clinical practice and research, a validated photonumeric scale is needed. To present scale-development methods for the Merz Lip Fullness Assessment Scale (MLFAS) and establish its reliability. A 5-point photonumeric scale was developed to objectively assess loss of lip volume using male and female subjects of various ages and skin types. To establish intra- and interrater reliability, 8 board-certified dermatologists and plastic surgeons evaluated 64 subjects live in 2 sessions, 2 weeks apart. The weighted kappa for intra- and interrater agreement were &ge; 0.6 in all cases. Intrarater agreement between the 2 rating sessions was nearly perfect (median weighted kappa = 0.911 and 0.930 for the upper lip and lower lip, respectively). Substantial interrater agreement between each rater pair was also demonstrated for both rating sessions, and ratings of upper and lower lip fullness showed comparable reliability. The MLFAS is a validated and reliable photonumeric scale for rating loss in lip volume. The scale maintains its reliability with reproducible results across a diverse group of males and females of various ages and Fitzpatrick skin types. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.7309.

Exploring the importance of inclusion criteria beyond the color of skin: Improvement in facial redness in skin of color subjects—An open-label, single center clinical study utilizing low molecular weight heparan sulfate

To the Editor: The awareness of skin of color (SOC) in dermatology is expanding; however, a lack of diversity in dermatologic clinical trials persists,1Elston D.M. Letter from the editor: diversity and inclusion in clinical trials link to JAAD-D-21-03191.J Am Acad Dermatol. 2022; 87: 981-982https://doi.org/10.1016/j.jaad.2022.05.041Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar especially considering the inclusion of African Americans/Blacks.2Okeke C.A.V. Bhayana M. Simmonds F.C. et al.Improving African American enrollment in hidradenitis suppurativa clinical trials: a clinical and research staff perspective.J Am Acad Dermatol. 2021; 85: AB47https://doi.org/10.1016/J.JAAD.2021.06.215Abstract Full Text Full Text PDF Google Scholar,3Ferguson J.E. Vetos D. Ho B.V. et al.Trends in diversity of participants in dermatology clinical trials over time: a systematic review.J Am Acad Dermatol. 2022; 86: 1403-1405https://doi.org/10.1016/J.JAAD.2021.05.052Abstract Full Text Full Text PDF Scopus (0) Google Scholar This study provides evidence of how SOC can be excluded and/or underestimated for severity of symptoms because redness can be overlooked by visual examination. This open-label, single center clinical study assessing SOC using clinical grading and biophysical testing reveals the positive results and benefits of a daily regimen containing a patented low molecular weight heparan sulfate—heparan sulfate analog (HSA). This work highlights how SOC subjects, especially those with darker skin tones, may be omitted from study analyses due to visual clinical grading limitations. Twelve subjects, Fitzpatrick skin types III to VI (African American/Black [75%], American Indian or Alaska Native [16.7%], and Asian [8.3%]), were included in the intent-to-treat population. Subjects used HSA and cleanser twice per day (AM/PM) and sunscreen SPF 52 tinted or SPF 49 untinted at least once per day (AM). Clinical evaluations were conducted at visit 1 (baseline), visit 2 (week 2), and visit 3 (week 4). Subjects participated in the following procedures at each time point: clinical grading of efficacy parameters,4Griffiths C.E. Wang T.S. Hamilton T.A. Voorhees J.J. Ellis C.N. A photonumeric scale for the assessment of cutaneous photodamage.Arch Dermatol. 1992; 128: 347-351https://doi.org/10.1001/archderm.1992.01680130061006Crossref PubMed Scopus (199) Google Scholar tolerability evaluations, Mexameter measurements, VISIA-CR imaging, and self-assessment questionnaires. Another component of the study was to collect skin swabs, at baseline and week 4, to analyze the inflammatory markers IL-1α, IL-1RA, and PGE2. Notably, none of the SOC subjects qualified for the swab study because of the criteria of having visible moderate to severe facial redness. Although there was a decrease in local cutaneous global erythema at 4 weeks compared to baseline evaluated by signs and symptoms of clinically graded facial redness (Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/6bw7rjn2db.1, upper panel), this was not as apparent as the decrease in facial redness captured by bioinstrumentation measurements (Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/6bw7rjn2db.1, middle panel). The HSA regimen resulted in true reduction in redness as assessed by the Mexameter measurements (2.2% decrease in melanin, 5.6% decrease in hemoglobin) (Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/6bw7rjn2db.1, middle panel) indicating an improvement in erythema/facial redness at 4 weeks compared to baseline that was not captured to the same extent by visible clinical grading. This resulted in exclusion of these individuals from the inflammatory marker assessment due to the lack of apparent moderate to severe facial erythema by visible clinical grading. The self-assessment questionnaire and tolerability evaluations (Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/6bw7rjn2db.1, lower panel) revealed the regimen did not cause cutaneous irritation and was highly favorable among subjects. The HSA regimen tested substantially improved redness in SOC (Fig 1 and Supplementary Fig 2, available via Mendeley at https://doi.org/10.17632/tjxzcpjycp.1). However, due to visible grading inclusion criteria, these subjects were excluded from any analysis to correlate the reduction in redness to reduced inflammation. This highlights the critical need for careful consideration and evaluation of the various cutaneous presentations in SOC to ensure that underlying redness and potential inflammation are not overlooked in this population. The use of biophysical testing and visible grading promotes the inclusion and retention of SOC in clinical studies. Such actions will prevent explicit and unconscious biases, ensuring medical grade skin care products are generalizable to all. ASB is a consultant for Senté, Inc. ES-O, VDC, and DO have participated in Advisory Boards for Senté, Inc. SH and CAVO have no conflicts of interest to declare. We kindly thank all study participants. Also, we would like to thank Tanya Rhodes, PhD for her critical review of the manuscript and feedback. The clinical study (SGS Stephens Study Number: C21-P009) was conducted by SGS Stephens, Inc, Phoenix Research Center (2421 West Peoria Ave, Suite 124 Phoenix, AZ 85029).

An Overview of Methods to Characterize Skin Type: Focus on Visual Rating Scales and Self-Report Instruments

Skin type classification is important because it provides guidance for professionals and consumers to recommend and select the most appropriate cosmetic products and skin care protocols and it is also important in clinical research. Several methods have been proposed for classifying skin typologies such as non-invasive bioengineering tools (examples: Corneometer® and Sebumeter®), visual and tactile methods (subjective methods that evaluate skin appearance, texture, temperature, and abnormalities), artificial intelligence-based tools and instruments (examples: visual rating scales, and self-report instruments). Examples of known visual rating scales used to classify skin aging are the Griffiths Photonumeric Scale, the Glogau Scale, and the SCINEXA Scale. The Fitzpatrick Skin Phototype Classification and the Baumann Skin Type System are some of the self-report instruments used for skin type classification. Despite the diversity of methods to classify skin type and degree of skin aging, data on instruments are scarce and not adequately compiled. Validation in larger samples and with individuals of different ethnicities and geographic locations is needed to promote a more universal use. Visual rating scales and instruments are interesting tools that allow the skin to be promptly and efficiently examined, without using costly or complex equipment, and are very useful in a clinical or self-assessment context.

Development and Validation of a Photonumeric Scale for Evaluation of Jawline Contour.

A naturally aged face is often characterized by a noticeable lack of jawline contour and decreased volume in the lower region. Several options are available to redefine the jawline. To objectively evaluate treatment-related improvements in clinical practice and research, a validated photonumeric scale is needed. To present scale-development methods for the Merz Jawline Assessment Scale and establish its reliability. A 5-point photonumeric scale was developed to objectively assess jawline volume loss and contour disruption using male and female subjects of various ages and skin types. Seven board-certified dermatologists and plastic surgeons evaluated 90 subjects live in 2 sessions, 3 weeks apart to establish intra- and interrater reliability. The weighted kappa for intra- and interrater agreement were &ge; 0.7 in all cases. Intrarater agreement between the 2 rating sessions was nearly perfect (median weighted kappa = 0.908). Substantial interrater agreement between each rater pair was also demonstrated for both rating sessions. The Merz Jawline Assessment Scale is a validated and reliable photonumeric scale for rating loss of jawline volume and contour. The scale maintains its validity and reliability with reproducible results across a diverse group of males and females of various ages and Fitzpatrick skin types. J Drugs Dermatol. 2023;22(2):203-209. doi:10.36849/JDD.7193.

Development and Validation of a Photonumeric Scale for Evaluation of Infraorbital Hollowing.

The infraorbital hollow is characterized by a sunken hollowing appearance of the junction between the lower eyelid and the cheek. Dermal fillers provide a suitable option to reduce the appearance of infraorbital hollowing. To objectively evaluate treatmentrelated improvements in clinical practice and research, a validated photonumeric scale is needed. To present the scale development methods for the Merz Infraorbital Hollow Assessment Scale and establish its reliability and clinical relevance. A 5-point photonumeric scale was developed to objectively assess the infraorbital hollowing among subjects of varying sex, age, and skin type. Intra- and inter-rater reliability was evaluated using live assessments conducted 2 weeks apart. The clinical relevance of a 1-point difference in scale-severity grade was evaluated through side by-side comparisons of photographs with either same grade or a one-grade difference. The scale demonstrated excellent reliability when used by trained physicians and other healthcare practitioners. Intra-rater agreement between the 2 live-subject rating sessions was nearly perfect. Substantial inter-rater agreement between the raters from both live sessions was also demonstrated. The mean absolute difference (95% confidence interval) in scale ratings was 1.08 (1.02, 1.14) for "clinically different" pairs and was 0.34 (0.27, 0.41) for "clinically same" pairs, suggesting a 1-point difference is clinically relevant. The Merz Infraorbital Hollow Assessment Scale is a validated, reliable, and clinically relevant photonumeric scale for rating infraorbital hollowing. The scale maintains its validity and reliability with reproducible results across a diverse group of males and females of various ages and Fitzpatrick Skin Types. J Drugs Dermatol. 2023;22(1):74-81.doi:10.36849/JDD.7191.

The Objective Stretch Marks Photonumeric Assessment Scale: A New and Complete Method to Assess Striae Distensae.

Striae distensae evaluation criteria have been recently described, but none is focused on objective striae assessment. With the purpose of better and objectively estimating the severity of striae distensae, the Objective Stretch Marks Assessment Scale has been developed by the authors' team. Seven hundred White patients were included in the study and assessed. To assess the severity of striae distensae, abdomen, breasts, hips, gluteal area, back area, thighs, calves, and upper limbs photonumeric grading scales were developed. The Rasch model was used as part of the validation process. A score was attributed to each patient, based on the scales we developed. The interrater reliability and test-retest reliability were analyzed. Eight photonumeric scales for striae distensae treatment outcomes assessment were developed. All scales exceeded criteria for acceptability, reliability and validity. The interrater and intrarater reliabilities were good, with a substantial or virtually perfect interrater reliability for the total score (P = 0.16). The authors' results allowed them to validate the Objective Stretch Marks Assessment Scale as a reliable and reproducible tool to assess striae distensae treatment outcomes. This scale could be also considered as an important new metric that can be used in clinical research.

Buttocks' Skin Laxity Severity Scale.

Clinical scales are useful to assess skin laxity in different areas of the body. To elaborate and validate a photonumeric scale to assess buttocks skin laxity. The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Validated 5 - Point photonumeric scales for the assessment of hand atrophy.

Quantifying the degree of dorsal hand atrophy is a challenging endeavor, but often necessary, in both the clinical and the research setting. The aim of this investigation was to create and consecutively validate a 5-point photonumeric scale for assessment of dorsal hand atrophy. A medical team created a novel 5-point photonumeric scale. Twelve international raters were involved in the digital validation, while five raters performed a live validation. For the digital validation of the Croma Hand Atrophy Assessment Scale, a total of 72subjects (58females, 14males) with a mean age of 43.0±14.4years [18-73years] were assessed. For the live validation, 88subjects (73females, 15males) with a mean age of 45.0±14.1years [20-73years] were rated. The results revealed almost perfect intra-rater (ICC: 0.90 [95% CI: 0.88-0.92]) and inter-rater agreements (ICC: 0.85 [95% CI: 0.81-0.89] and 0.86 [95% CI:0.82-0.89]) in the digital validation and substantial intra-rater (ICC: 0.79 [95% CI: 0.75-0.82]) and inter-rater agreements (ICC: 0.75 [95% CI: 0.68-0.81] and ICC: 0.67 [95% CI: 0.54-0.77]) in the live validation. The created scale to assess dorsal hand atrophy has been shown to provide substantial-to-almost perfect agreement in the digital and live validation cycles and reached comparable intra-rater and inter-rater agreement to already published and validated scales. It is expected that the created scale will help physicians and researchers in the assessment of hand atrophy in the clinical and research setting in the future.

Creation and validation of a photonumeric scale for assessment of lip fullness.

BackgroundValidated, objective clinical scales are needed to assess aesthetic improvement of the lips after augmentation with dermal fillers.ObjectiveTo develop a lip fullness rating scale and establish its reliability for grading subjects in clinical trials or routine practice, and sensitivity for detecting clinically meaningful changes.MethodsThe Teoxane Lip Fullness Scale (TLFS), a proprietary, 5‐grade photonumeric scale, was developed by clinical experts based on real subject photographs and was validated through both photographic and live subjects' evaluation.ResultsClinician intra‐ and inter‐rater agreement for the TLFS was substantial to almost perfect. Mean intra‐rater weighted Kappa score between the two rounds of photographic validation was 0.92, and inter‐rater agreement was substantial with an ICC of 0.93 for the combined rounds. Average intra‐rater weighted Kappa score and inter‐rater ICC for the live validation were equally high, reaching 0.91 and 0.89 respectively. Additionally, evaluators identified clinically significant differences between photographs of subjects presenting a 1‐grade or 2‐grade difference on the scale in 90% and 98% of cases, respectively.ConclusionsThe intra‐rater Kappa scores and inter‐rater ICC met their pre‐determined acceptance criteria of >0.70 in the photographic and live validation. The TLFS was shown to be a repeatable and reproducible Clinician Reported Outcome (Clin‐RO) for healthcare providers to classify lip fullness both in clinical trials and in routine patient care. A 1‐grade difference on the TLFS can detect a clinically meaningful difference in lip fullness.

Treatment of Cutaneous Photoaging of Glabella with Autologous Platelet Concentrate

Introduction: Platelet rich plasma (PRP) is an autologous blood product obtained after centrifugation of the blood. Contains high concentrations of platelets and growth factors. It is currently a very popular therapy in dermatology; however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of intradermal microinjection of autologous platelet concentrate (APC) in the treatment of glabella rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 60 patients from the Hospital Clínico Quirúrgico: “Hermanos Ameijeiras”, in the period between March 1, 2017 and March 31, 2020. The treatment was applied monthly. for 1 year. The final evaluation was carried out 3 months after the end of the treatment. Results: 60 women with an average age of 45 ± 4.3 years were treated. After treatment, there were significant changes in the Glogau Photo Damage Scale (P = 0.012), in the Photo numeric Scale for evaluating the severity of glabella wrinkles (P = 0.031) and in the Global Aesthetic Improvement Scale (P = 0.012). The adverse events found were pain, inflammation and ecchymosis. The degree of satisfaction reported by the patients was good (25.0%) and very good (75.0%) (P = 0.027). Conclusions: The autologous platelet concentrate proved to be effective and safe in reducing the signs of skin aging in glabella, associated with a high degree of patient satisfaction.

Validated 5-point photonumeric scales for the assessment of the jowls and chin.

The objective of this investigation was to create and to examine the reproducibility and validity of 5-point photonumeric assessment scales that allow objective assessment of chin retrusion and jawline sagging using a digital and a live validation. Two new 5-point photonumeric scales created to assess chin projection and jawline sagging were validated by 12 experts in a digital validation and by 5 experts in a live validation setting. Intra-rater agreement and inter-rater agreement were assessed. For the digital validation, an almost perfect intra-rater (Kappa: 0.89 [95% CI: 0.86-0.91]) and almost perfect inter-rater agreement in both sessions (Kappa: 0.80 [95% CI: 0.74-0.86] and 0.80 [95% CI: 0.74-0.86]) was achieved for the Croma Chin Projection Assessment Scale, while intra-rater agreement (Kappa: 0.88 [95% CI: 0.85-0.91]) was almost perfect for the Croma Jawline Sagging Assessment Scale and inter-rater agreement being substantial in the first session (Kappa: 0.76 [95% CI: 0.71-0.81]) and almost perfect in the second session (Kappa: 0.81 [95%CI: 0.76-0.85]). For the live validation, intra-rater agreement was almost perfect for the Croma Chin Projection Assessment Scale (Kappa: 0.82 [95%CI: 0.74-0.90]) and the Croma Jawline Sagging Assessment Scale (Kappa: 0.83 [95%CI: 0.77-0.89]), while inter-rater agreement was substantial in both sessions for both scales. The created chin and jawline photonumeric grading scales are valid and reliable tools for assessing chin projection and jawline sagging. The scales will be of value for standardized chin evaluation and quantifying outcomes in clinical research and daily practice.

Validated 5‐point photonumeric scales for the assessment of the periorbital region

The objective of this investigation was to create and validate 5-point photonumeric scales for the assessment of dynamic crow's feet, static crow's feet, and infraorbital hollows. Three novel 5-point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale. The statistical analysis revealed almost perfect intra-rater and inter-rater reliability in the digital validation of the scales for the assessment of static and dynamic crow's feet as well as infraorbital hollows. In the live validation, both crow's feet scales showed almost perfect intra-rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra-rater reliability. Inter-rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow's Feet Assessment Scale, Croma Static Crow's Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting. The created scales to assess infraorbital hollowing, dynamic and static crow's feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age-dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.