Poster Presentation ASDR Annual Scientific Meeting 2019

Characterization of acne induced hyperpigmentation and testing of Post acne hyperpigmentation index in the Sri Lankan setting. (#39)

Niranjan Ariyasinghe 1 2 , Upul Senarath 3 , Haniya Azmy 2 , Roshani Poddalgoda 1 , Fathima Rimzina 1
  1. Dermatology, District General Hospital , Negombo, Sri Lanka
  2. Specialist Skin Centre, Colombo , Sri Lanka
  3. Community Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka


Studies addressing the characteristics of acne induced post inflammatory hyperpigmentation (PIH) including, prevalence, associated features or the impact are scarce. No formal grading system has been tested on patients from the subcontinent.


We embarked on describing features of acne related pigmentation and testing a new instrument, postacne hyperpigmentation index (PAHPI), on Sri Lankan patients with acne induced PIH. 


All patients (n=73) who presented with acne and or any complication(s) of acne within a period of a month, to skin clinic of a District General Hospital and the aesthetic clinic of a tertiary care private Hospital were entered into the study. Each patient was interviewed and examined by an experienced consultant and a trained medical officer. The expert clinically graded the acne severity and both scored independently, using the PAHPI. Various other associated factors were recorded.


Sixty nine (94.5%) patients had some degree of pigmentation; thirty eight (52%) had moderate and severe pigmentation on clinical grading. Majority of the participants found pigmentation to be equal to or more troublesome than acne itself. (60%) Highly significant correlation was seen between the scores given, using the PAHPI by expert and the trainee. [r=0.8; P<0.01] Furthermore, high degree of inter-rater agreement (between expert and trainee) was observed comparing the categories -mild/moderate/severe- using the PAHPI. [Kappa = 0.615]. Correlation between global severity rank (clinical grading) and PAHPI rank by the Consultant was moderately high. [Kappa = 0.557].


PAHI is a reliable tool to grade severity of acne induced hyperpigmentation which is a very common and a troublesome sequel among our patients.


  1. A global perspective on the epidemiology of acne. Tan JK, Bhate K. Br J Dermatol. 2015 Jul; 172 Suppl 1:3-12
  2. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. Perkins AC, Cheng CE, Hillebrand GG, Miyamoto K, Kimball AB. J Eur Acad Dermatol Venereol. 2011 Sep; 25(9):1054-60.
  3. Profile of acne vulgaris--a hospital-based study from South India. Adityan B1, Thappa DM. Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 272-8.
  4. Understanding the burden of adult female acne.Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD J Clin Aesthet Dermatol. 2014 Feb; 7(2): 22-30
  5. Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne. Callender VD, Alexis AF, Daniels SR, Kawata AK, Burk CT, Wilcox TK, Taylor SC. J Clin Aesthet Dermatol. 2014 Jul; 7(7): 19-31
  6. Evaluating acne-related post-inflammatory hyperpigmentation is a challenge even amongst experts. Goh CL, Abad-Casintahan F, Chow SK, Kubba R, Miyachi Y, Noppakun N, See J,Suh DH, Xiang LF, Kang S J Dermatol. 2014 Dec; 41(12): 1106-8
  7. Reliability assessment and validation of the post acne hyperpigmentation index (PAHPI), a new instrument to measure post inflammatory hyperpigmentation from acne vulgaris. Savory SA, Agim NG, Mao R, Peter S, Wang C, Maldonado G, Bearden Dietert J, Lieu TJ, Wang C,Pretzlaff K, Das S, Vandergriff T, Lopez IE, Litzner BR, Hynan LS, Arellano-Mendoza MI, Bergstresser PR,Pandya AG . J Am Acad Dermatol. 2014 Jan; 70(1): 108-14
  8. Top dermatologic conditions in patients of color: an analysis of nationally representative data. Davis SA, Narahari S, Feldman SR, Huang W, Pichardo-Geisinger RO, McMichael AJ J Drugs Dermatol. 2012 Apr; 11(4): 466-73
  9. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. Davis EC, Callender VD. J Clin Aesthet Dermatol. 2010 Apr; 3(4): 24-38.
  10. European evidence-based (S3) guideline for the treatment of acne - update 2016 Nast A, Dréno B, Bettoli V, Bukvic Mokos Z, Degitz K, Dressler C, Finlay AY, Haedersdal M, Lambert J, Layton A, Lomholt HB1, López-Estebaranz JL, Ochsendorf F, Oprica C, Rosumeck S, Simonart T, Werner RN,Gollnick H. J Eur Acad Dermatol Venereol. 2016 Aug; 30(8): 1261-8.
  • Are you an ECR (within 4 years of conferring of PhD)?: No
  • Are you an ECR (within 4 years of conferring of PhD)?: No