NIHR | Manchester Biomedical Research Centre

A photonumeric scale for the assessment of atrophic facial photodamage

What’s already known?

Photonumeric scales demonstrate consistent superiority when compared to descriptive equivalents. Hypertrophic facial photodamage has been assessed successfully in terms of both severity and treatment response using a well-established photonumeric scale.


  • A pool of 393 facial photographs (en face and 45º oblique) from 131 individuals with atrophic facial photodamage was created.

A photonumeric scale for the assessment of atrophic facial photodamage

Dr Jean Ayer discusses her paper in the British Journal of Dermatology – A photonumeric scale for the assessment of atrophic facial photodamage

  • Five photographic standards were selected and assigned grades 0 through 8, where 0 is no photodamage and 8 is severe atrophic photodamage, thus making a nine-point scale.
  • Twenty photographs spanning the entire range of values were selected to test the scale.
  • Testing was performed alongside a descriptive equivalent.
  • A panel of 10 dermatologists, 10 non-dermatology clinicians and 14 dermatology scientists marked the two scales; marking was repeated one week later.


There was a significantly greater agreement between the graders using the photonumeric scale than the descriptive scale (kappa values 0.71 and 0.37 with standardised errors of 0.57 and 0.17 respectively) with no significant difference in repeatability between the two methods (p < 0.05)

What does this study add?

A new photonumeric scale created and validated for the assessment for a newly recognised clinical phenotype of facial photodamage-atrophic photodamage.

Atrophic facial photodamage is known to be permissive for the development of keratinocyte carcinoma. Thus, any technology that allows clinicians to easily recognise and measure this form of photodamage will be a welcome addition to dermatological practice.


This new nine-point photographic scale, which shows strong repeatability and reproducibility, should be useful in categorising atrophic subjects in epidemiological studies where photodamage severity is either studied, or thought to be a factor in the relevant endpoint.

The scale will also be useful in characterising atrophic individuals entering clinical trials for treatment of photodamage or for conditions where atrophic photodamage severity is a relevant cofactor.

Read the paper in full doi.org/10.1111/bjd.16331