DPASI Is a Reliable Instrument for Assessing Severity of Acquired Dermal Macular Hyperpigmentation

DPASI divides the face and neck into 6 segments to identify disease severity in each segment, using dermatoscopy.

A new study has found that the objective dermal pigmentation area and severity index (DPASI) scoring system, which divides the face and neck into 6 segments to identify disease severity in each segment, using dermatoscopy, is reliable for the assessment of acquired dermal macular hyperpigmentation (ADMH) severity.

A total of 55 patients with ADMH were independently rated on the DPASI by 3 researchers on 2 consecutive days within 1 week. Test-retest reliability of DPASI was investigated by administering the index at baseline and within 7 days in patients who were asked to wear topical sunscreen. Interrater agreement was assessed by each investigator, who scored patients without the knowledge of the other researchers’ scores. The DPASI was compared with the physician global assessment score to evaluate validation of the index.

All 3 raters had good correlation for test-retest reliability by Person’s r (r = 0.984 [P <.0001]; r = 0.983 [P <.000]; and r = 0.970 [P <.0001], respectively). Intraclass correlation coefficient demonstrated good correlation for interrater agreement (intraclass correlation coefficient = 0.997; P <.0001). In both face and content validity, the score fared well, as demonstrated by an overall mean Content Validity Index for Items of 0.87 for the DPASI. On a 1 to 5 scale, there was a median score of 4 for usability. The 3 investigators took a mean time of 307.2±83 seconds, 308.9±84.4 seconds, and 350.15±91.8 seconds, respectively, to score the patients.

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Limitations of the study include the small sample size, the inclusion of patients from a single center, and the lack of patients with newly diagnosed psoriasis, all of which may limit generalizability of the findings.

On the basis of their findings, the researchers concluded that the DPASI “can be used in clinical trials to assess efficacy of drugs and also in day-to-day clinical practice to measure the severity of [ADMH].”

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Kumaran MS, Dabas G, Vinay K, Parsad D. Reliability assessment and validation of the dermal pigmentation area and severity index: a new scoring method for acquired dermal macular hyperpigmentation [published online February 22, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15516.