Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202501082
Jornal Vascular Brasileiro
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Evaluation of a clinical score to predict post-sclerotherapy hyperpigmentation compared with the Skin Hyperpigmentation Index: a prospective Skin Code study

Avaliação de um escore clínico para predição de hiperpigmentação pós-escleroterapia em comparação com o Índice de Hiperpigmentação Cutânea: estudo prospectivo Skin Code

Renata Camila Barros Rodrigues; Samantha Neves; Eduardo Ramacciotti; Viviane Santana da Silva; Roberto Augusto Caffaro; Flávia Magalhães Silveira Magella Oliveira; Alexandre Fioranelli; Rebeca Higino Becker

http://dx.doi.org/10.1590/1677-5449.202501082 J Vasc Bras, vol.25, e20250108, 2026
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Abstract

Post-sclerotherapy hyperpigmentation (PSH) is a common complication following sclerotherapy for telangiectasias and reticular veins. However, tools for pre-procedural prediction of PSH are limited, making pre-treatment identification of patients at greater risk a challenge. This research aimed to evaluate a clinical scoring system (Skin Code Score) designed to estimate the individual risk of PSH. A prospective, single-center, single-arm study was conducted. Adult female patients with telangiectasias and reticular veins were treated and evaluated for pigmentation risk using the Skin Code Score (range, 2-12 points). Hyperpigmentation was assessed at baseline and on day 30 by in-person evaluation performed by one vascular surgeon, complemented by photographic analysis conducted independently by two other vascular surgeons and one dermatologist. Skin Hyperpigmentation Index (SHI) measurements were used for objective correlation with the Skin Code Score. The Skin Code Score showed strong interobserver agreement and reproducibility (κ ≥ 0.85). Diagnostic accuracy ranged from 82.8% to 94.7% among evaluators. A score of 12 predicted PSH in up to 99.8% of cases, while a score of 8 indicated a probability of approximately 76%. The study was limited by a small sample size and its single-center design; a proportion of the assessments were conducted by photographic analysis. It is concluded that the Skin Code Score is a simple and reproducible tool for predicting PSH and could assist clinicians with pre-procedural risk stratification, patient counseling, and clinical decision-making.

Keywords

post-inflammatory hyperpigmentation; telangiectasias; reticular veins; sclerotherapy; skin

Resumo

A hiperpigmentação pós-escleroterapia (HPE) é uma complicação comum após a escleroterapia de telangiectasias e veias reticulares. No entanto, os instrumentos para predição pré-procedimento da HPE são limitados, tornando desafiadora a identificação de pacientes com maior risco antes do tratamento. A pesquisa objetivou avaliar um sistema de escore clínico (Skin Code Score) desenvolvido para estimar o risco individual de HPE. Foi realizado um estudo prospectivo, unicêntrico e de braço único. Pacientes adultas do sexo feminino com telangiectasias e veias reticulares foram tratadas e avaliadas quanto ao risco de pigmentação utilizando o Skin Code Score (intervalo de 2 a 12 pontos). A hiperpigmentação foi avaliada no 1° dia e no 30º dia por meio de exame presencial realizado por um cirurgião vascular, complementado por análise fotográfica conduzida de forma independente por dois cirurgiões vasculares e um dermatologista. Medidas do Índice de Hiperpigmentação Cutânea (Skin Hyperpigmentation Index – SHI) foram utilizadas para correlação objetiva com o Skin Code Score. O Skin Code Score apresentou forte concordância interobservador e reprodutibilidade (κ ≥ 0,85). A acurácia diagnóstica variou de 82,8% a 94,7% entre os avaliadores. Um escore de 12 previu HPE em até 99,8% dos casos, enquanto um escore de 8 indicou probabilidade aproximada de 76%. O estudo foi limitado pelo pequeno tamanho amostral e pelo delineamento unicêntrico; parte das avaliações foi realizada por meio de análise fotográfica. Conclui-se que o Skin Code Score é uma ferramenta simples e reprodutível para a predição de HPE e pode auxiliar os médicos na estratificação de risco pré-procedimento, no aconselhamento dos pacientes e na tomada de decisão clínica.

Palavras-chave

hiperpigmentação pós-escleroterapia; telangiectasias; veias reticulares; escleroterapia; pele

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Submitted date:
11/05/2025

Accepted date:
08/09/2026

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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