title: Reliability assessment and validation of the postacne hyperpigmentation index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris.
abstract: BACKGROUND
  There are no validated outcome measures for postinflammatory hyperpigmentation (PIH).
  
  
  OBJECTIVE
  We sought to determine the reliability and validity of an outcome measure for PIH after acne in patients with skin of color.
  
  
  METHODS
  A postacne hyperpigmentation index (PAHPI) was developed. Six raters scored 21 patients with PIH twice. Reliability was determined within and between raters, whereas validity was evaluated by comparing scores with severity ranking by an independent dermatologist. The pigment intensity scores were compared with the melanin index of each patient using a narrowband reflectance spectrophotometer. A quality-of-life score (Skindex-29) was also compared with PAHPI scores.
  
  
  RESULTS
  Total PAHPI scores showed good reliability within and between raters and were valid when compared with clinical severity and melanin indices. Good correlation was achieved between the total PAHPI score and the emotion subscale of the Skindex-29.
  
  
  CONCLUSIONS
  Generalizability of results is limited to African American females.
  
  
  CONCLUSIONS
  The PAHPI shows good reliability and validity when scored on patients with PIH from acne vulgaris. The PAHPI also correlates well with the emotional impact of PIH as measured by the Skindex-29. Future studies should assess the ability of the PAHPI to change with improvement of PIH from acne after treatment.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Savory
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Nnenna G
authors.initials: NG
authors.lastname: Agim
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rui
authors.initials: R
authors.lastname: Mao
authors.affiliation: Meharry Medical College, Nashville, Tennessee.
authors.forename: Shayna
authors.initials: S
authors.lastname: Peter
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Casey
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Maldonado
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bearden Dietert
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Tiffany Jane
authors.initials: TJ
authors.lastname: Lieu
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Christy
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Kara
authors.initials: K
authors.lastname: Pretzlaff
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Shinjita
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Travis
authors.initials: T
authors.lastname: Vandergriff
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Isha E
authors.initials: IE
authors.lastname: Lopez
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Litzner
authors.affiliation: Department of Clinical Sciences (Biostatistics) and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.affiliation: Hospital General de México, Mexico City, Mexico.
authors.forename: Maria Ivonne
authors.initials: MI
authors.lastname: Arellano-Mendoza
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Bergstresser
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: amit.pandya@utsouthwestern.edu.
authors.forename: Amit G
authors.initials: AG
authors.lastname: Pandya
mesh_terms: D000152:Acne Vulgaris / Q000150:complications* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D044466:Asian People; D003872:Dermatitis / Q000473:pathology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology* / Q000473:pathology* / Q000523:psychology; D008297:Male; D008543:Melanins / Q000032:analysis; D015588:Observer Variation; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013053:Spectrophotometry; D055815:Young Adult
chemical_list: D008543:Melanins
keywords: ICC; PAHPI; PIH; Spearman rank order correlation; acne vulgaris; clinical trials; evidence-based medicine; hyperpigmentation; intraclass correlation coefficient; outcome measures; pigment; pigmentation; postacne hyperpigmentation index; postinflammatory; postinflammatory hypermelanosis; postinflammatory hyperpigmentation; rho; skin of color; validation