Evaluation of a clinical score to predict post-sclerotherapy hyperpigmentation compared with the Skin Hyperpigmentation Index: a prospective Skin Code study.

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.