Many patients present to dermatologists with the complaint of dyspigmentation. This is a broad term, which includes disorders of melanin deposition, disorders of superficial vasculature, and disorders of both. Examples of melanin deposition include lentigines and post-inflammatory pigmentation. Examples of disorders of the superficial vasculature include telangiectasias, spider angiomas and rosacea. A combination of melanin deposition and prominent vasculature is found in dermatoheliosis. In order to evaluate these diseases, dermatologists have developed qualitative or semi -quantitative tests such as the melasma area and severity index (MASI).1 These tools have been used most commonly to evaluate efficacy of treatment for dyspigmentation and the effects of skin conditions on quality of life. However, many of these analyses are cumbersome in a busy clinical practice and too abstract for patients. These scales have shown to be more relevant for research than for clinical applications.
The VISIA Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ, Figure 1) is a new device used to measure a patient’s dyschromia, and it is clinically applicable. The VISIA system generates a series of photographs using standard, ultraviolet and cross polarized lighting. The photographs provide a visual to patients that may help them understand their skin complaints. The system also analyzes the photographs to quantify the skin complaint and count the number of lesions, such a brown spots or dilated pores. The system further demonstrates how each subject’s findings compare to the skin type of aged matched controls and generates a percentile where the subject falls on the distribution.2-4 A similar system, the VISIA CR, has been used for research purposes.
VISIA uses standard flash lighting to identify spots, rhytides, texture and pore size (Figure 2, Table 1).3, 4 Spots are identified by their color and contrast from the surrounding skin, including freckles, acne scars, and vascular lesions. Rhytides are recognized by their long narrow shape. Of note, there can be variation in the measurement of rhytides based on facial expression. The standard lighting images can also assess the texture of the skin, reporting elevations and depressions on the skin surface. Finally, pore size is identified by focusing on the spots that are very small.4
Ultraviolet lighting is used to generate an ultraviolet spot image and a porphyrin image (Figure 2, Table 1). The ultraviolet lighting takes advantage of the selective absorption of ultraviolet light by epidermal melanin in comparison to deeper melanin,
