Development and validation of the dermoscopy haemangioma activity index (DHAI) - A pilot study

Background Various dermoscopy patterns and structures in infantile haemangioma (IH) can be used to identify its activity and assess the response to therapy. Aim To formulate and validate a scoring system for IH based on dermoscopy - dermoscopy haemangioma assessment index (DHAI). To compare DHAI with the haemangioma activity score (HAS). Methods Consecutive patients with IH were taken for the study. At the time of presentation, each IH was clinically and by dermoscopy assessed by the first dermatologist. Clinical and dermoscopic images were taken and retrospectively analysed by a second and third dermatologist. The agreement between the three dermatologists was assessed using the inter-class correlation coefficient. Results The study included 45 patients with IH. Among the three observers, reliability analysis showed satisfactory results for DHAI with a Cronbach's alpha coefficient of 0.983, indicating good reliability and consistency. Inter-item correlation between all three observers was found to be positive and statistically significant (p-value <0.001). Thus, there was good agreement between the three dermatologists. On comparing with Haemangioma Activity Score (HAS), the correlation between HAS and DHAI was 0.703, which implies a high positive correlation. Limitations The primary limitation in our study was the very small number of patients. Secondly, the scoring system was not assessed longitudinally, so improvement in parameters with time could not be measured. Thirdly, the scoring system was not able to accurately measure the depth of IH. Conclusion DHAI is a good, reliable, and valid scoring system to assess the activity of IH, and can be used for future interventional studies on IH. DHAI can simplify the scoring of IH using a dermoscope and can provide more objective information as compared to the previous scoring system.