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

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.