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Box counting serial image index (BCSI) versus point counting serial image index (PCSI) in scoring melasma: A

Papishetty Prathyusha¹, Jabeen Nihaa¹, Rangappa Vinutha¹

¹Department of Dermatology Venereology & Leprosy, JSS Medical College and Hospital, JSS Academy of Higher Education and Research (Deemed to be University), Mysuru, Karnataka, India.

Indian Journal of Dermatology, Venereology and Leprology

|June 30, 2025

Summary

The new Box counting serial image index (BCSI) is a faster and more accurate method for assessing melasma severity than the traditional Point counting serial image index (PCSI). BCSI improves upon PCSI by directly capturing images, overcoming previous limitations.

Keywords:

Box counting serial image index (BCSI)objective area measurement point counting serial image index (PCSI)

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Area of Science:

Dermatology
Medical Imaging
Quantitative Analysis

Background:

Melasma assessment relies on scoring methods like the Point counting serial image index (PCSI).
PCSI has limitations, including difficulties with double tracing and assessing scattered pigmentation.
There is a need for improved, objective methods for melasma severity evaluation.

Purpose of the Study:

To introduce and validate a modified scoring method, the Box counting serial image index (BCSI).
To compare the efficacy and efficiency of BCSI against the established PCSI for melasma assessment.
To address the limitations of PCSI in quantifying melasma area and severity.

Main Methods:

The Box counting serial image index (BCSI) method involves placing a preset grid over serial images.
Each speck of pigmentation is counted as one grid box to determine the area involved.
Melasma score is calculated as Area x Intensity of pigmentation (0-5 scale), with time taken recorded.

Main Results:

Both BCSI and PCSI demonstrated significant decreases in total scores over time with treatment (p<0.0003).
BCSI showed sensitivity to treatment-induced changes, similar to PCSI.
The mean time required for BCSI assessment was significantly lower than that for PCSI (p < 0.0003).

Conclusions:

The Box counting serial image index (BCSI) effectively overcomes the limitations of PCSI.
BCSI offers a more direct, rapid, and potentially easier method for assessing melasma.
BCSI provides a validated, sensitive tool for tracking melasma changes over time.