Goh Chee Leok, Abad-Casintahan Flordeliz, Chow Steven K W, Kubba Raj, Miyachi Yoshiki, Noppakun Nopadon, See JoAnn, Suh Dae Hun, Xiang Leihong Flora, Kang Sewon
National Skin Centre, Singapore.
J Dermatol. 2014 Dec;41(12):1106-8. doi: 10.1111/1346-8138.12667. Epub 2014 Oct 20.
Post-inflammatory hyperpigmentation (PIH) is a problematic and distressing acne sequela. The difficulty of clinically assessing and managing post-inflammatory hyperpigmentation is especially prevalent in Asian populations. The Asian Acne Board conducted a study to evaluate concordance in diagnosis of post-inflammatory hyperpigmentation in patients with active acne, acne scarring, and pigmentation problems. Seven dermatologists reviewed 64 anonymous clinical photographs projected onto a screen during a single session. Results showed that there were two groups of raters, those who found a high frequency of PIH and those who found a low frequency. There was significant variability in these two groups in rating the presence of PIH, with an average of 30 diagnoses (24%) difference between high- and low-frequency raters. Results of severity ratings showed that while most cases of PIH were assessed as mild, there was marked variability between raters in their assessments of severity. Overall, variability in PIH diagnosis was greatest when active acne was present; in these cases, low PIH raters were more likely to report skin coloration as erythema instead of PIH. These findings uphold the importance of utilizing specific clinical criteria to improve accurate evaluation of skin color and we advocate future research into this area.
炎症后色素沉着（PIH）是一种棘手且令人苦恼的痤疮后遗症。临床上评估和处理炎症后色素沉着的困难在亚洲人群中尤为普遍。亚洲痤疮委员会开展了一项研究，以评估患有活动性痤疮、痤疮瘢痕和色素沉着问题的患者炎症后色素沉着诊断的一致性。七位皮肤科医生在一次会议期间审阅了投射在屏幕上的64张匿名临床照片。结果显示有两组评估者，一组发现PIH的频率高，另一组发现的频率低。这两组在评定PIH的存在情况时存在显著差异，高频和低频评估者之间平均有30个诊断结果（24%）的差异。严重程度评级结果显示，虽然大多数PIH病例被评估为轻度，但评估者在严重程度评估方面存在显著差异。总体而言，当存在活动性痤疮时，PIH诊断的差异最大；在这些病例中，低频PIH评估者更有可能将皮肤色素沉着报告为红斑而非PIH。这些发现支持了利用特定临床标准来改善皮肤颜色准确评估的重要性，我们提倡未来对此领域进行研究。
