Comparison of methods to estimate the affected body surface area and the dosage of topical treatments in psoriasis and atopic dermatitis: the advantage of a picture‐based tool
R Speeckaert I Hoorens S Corthals L Delbaere J Lambert T Lesseliers S Mylle K Ongenae S De Schepper L De Smet M Speeckaert N van Geel
First published: 05 June 2019 https://doi.org/10.1111/jdv.15726
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jdv.15726
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Abstract
Background
The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks.
Objective
To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user‐friendliness and timing.
Methods
In this study, we compared the reliability of 3 different methods: (1) the fingertip unit calculated by the 1% hand rule; (2) a picture‐based tool [termed cutaneous inflammatory disease extent score (CIDES)] and (3) a digital drawing tool. 11 observers scored 40 patients with psoriasis and eczema to assess the inter‐ and intrarater reliability. Timing was automatically recorded and user‐friendliness was investigated by a questionnaire.
Results
An excellent intraclass correlation (ICC) was found for both inter‐ and intrarater agreement for the picture‐based tool (ICC=0.92 and ICC=0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased interrater variability although an excellent intrarater agreement was found (ICC=0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 sec).
Conclusion
A picture‐based method offered the most advantages (in terms of reliability, speed and user‐friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.
R Speeckaert I Hoorens S Corthals L Delbaere J Lambert T Lesseliers S Mylle K Ongenae S De Schepper L De Smet M Speeckaert N van Geel
First published: 05 June 2019 https://doi.org/10.1111/jdv.15726
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jdv.15726
ePDFPDFTOOLS SHARE
Abstract
Background
The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks.
Objective
To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user‐friendliness and timing.
Methods
In this study, we compared the reliability of 3 different methods: (1) the fingertip unit calculated by the 1% hand rule; (2) a picture‐based tool [termed cutaneous inflammatory disease extent score (CIDES)] and (3) a digital drawing tool. 11 observers scored 40 patients with psoriasis and eczema to assess the inter‐ and intrarater reliability. Timing was automatically recorded and user‐friendliness was investigated by a questionnaire.
Results
An excellent intraclass correlation (ICC) was found for both inter‐ and intrarater agreement for the picture‐based tool (ICC=0.92 and ICC=0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased interrater variability although an excellent intrarater agreement was found (ICC=0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 sec).
Conclusion
A picture‐based method offered the most advantages (in terms of reliability, speed and user‐friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.
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