Development of a new classification and scoring system for scalp conditions: Scalp Photographic Index (SPI)

Figures & data

Figure 1. (a) A scalp image taken with a dermoscope (×20 magnification, non-polarized, Dermlite DL4™, DermLite, San Juan Capistrano, CA). (b) A scalp image of the same individual taken with a trichoscope (×60 magnification, ASM-202™ camera, Aram Huvis Co., Ltd., Seongnam, South Korea). (c) The Scalp Positioning Ruler was used to constantly photograph five areas of the scalp. (d) Five areas to measure scalp conditions for the Scalp Photographic Index (vertex, anterior, posterior, right, and left).

Figure 2. The photographic scale for the Scalp Photographic Index. Dryness is determined by fine lines, scales, and fissures of the surface; mild = 1 (fine lines or scant, tiny scales), moderate = 2 (clearly visible tiny scales), and severe = 3 (fissures or prominent tiny scales). Oiliness is determined by sebum accumulation and shine of the surface; mild = 1 (evenly shiny surface), moderate = 2 (accumulation of sebum around hair pores), and severe = 3 (prominent accumulation of greasy sebum). Erythema is determined by erythema and telangiectasia between the hair pores; mild = 1 (faint pink between hair pores), moderate = 2 (dull red between hair pores), and severe = 3 (fiery red or telangiectasia between hair pores). Folliculitis is determined by erythema and pustules of hair pores; mild = 1 (mild erythema around hair pores), moderate = 2 (moderate erythema or some pustules/crusts around hair pores), and severe = 3 (severe erythema or extensive pustules/crusts around hair pores). Dandruff is determined by coarse and large scales of the surface; mild = 1 (slight dandruff), moderate = 2 (clearly visible dandruff), and severe = 3 (prominent dandruff).

Table 1. Relationship between the Scalp Photographic Index (SPI) and the scores evaluated by the patients and one investigator.

		SPI
		Dryness	Oiliness	Erythema	Folliculitis	Dandruff
Investigator	Dryness	0.810 (<0.001*)	–0.328 (0.001*)	0.022 (0.831)	–0.043 (0.672)	0.406 (<0.001*)
	Oiliness	–0.360 (<0.001*)	0.664 (<0.001*)	0.219 (0.029*)	0.057 (0.573)	–0.044 (0.660)
	Erythema	0.060 (0.553)	–0.030 0.765	0.787 (<0.001*)	0.394 (<0.001*)	–0.079 (0.434)
	Folliculitis	–0.039 (0.700)	0.063 0.531	0.440 (<0.001*)	0.729 (<0.001*)	–0.009 (0.927)
	Dandruff	0.264 (0.008*)	0.250 (0.012*)	–0.279 (0.005*)	–0.189 (0.060)	0.797 (<0.001*)
Patients	Warmth	–0.228 (0.022*)	0.217 (0.030*)	0.306 (0.002*)	0.214 (0.032*)	–0.275 (0.006*)
	Itch	0.054 0.595	–0.171 0.089	–0.273 (0.006*)	–0.136 0.178	0.095 0.345
	Pain	–0.001 0.990	0.100 0.324	0.219 (0.029*)	0.152 0.132	0.068 0.500
	Pimple	0.036 0.721	–0.154 0.127	0.092 0.362	0.336 (0.001*)	–0.112 0.266

The data are presented as Pearson’s correlation coefficients (p values).

* p< .05.

Table 2. Inter-rater and intra-rater reliabilities of the Scalp Photographic Index.

Kendall’s W (p value)^a for inter-rater reliability
By raters
All raters (N = 20)	0.84 (<.0001)
Dermatologists (N = 6)	0.91 (<.0001)
Dermatology residents (N = 10)	0.82 (<.0001)
Nurses (N = 4)	0.85 (<.0001)
By subscales
Dryness	0.79 (<.0001)
Oiliness	0.79 (<.0001)
Erythema	0.88 (<.0001)
Folliculitis	0.83 (<.0001)
Dandruff	0.83 (<.0001)
ICC(3,1) (95% CI)^b for intra-rater reliability
All raters (N = 20)	0.94 (0.93–0.95)
Dermatologists (N = 6)	0.98 (0.97–0.99)
Dermatology residents (N = 10)	0.95 (0.94–0.97)
Nurses (N = 4)	0.88 (0.81–0.93)

^a Kendall’s W: <0.20, poor agreement; 0.21–0.40, fair agreement; 0.41–0.60, moderate agreement; 0.61–0.80, good agreement; 0.81–1.00, excellent agreement.

^b ICC(3,1): <0.50, poor agreement; 0.51–0.75, moderate agreement; 0.76–0.90, good agreement; 0.91–1.00, excellent agreement.

Data availability statement

For any purpose, with investigator support, anyone can request the data through email-id [email protected]