Howell Kevin J, Lavorato Antonia, Visentin María Teresa, Smith Roy E, Schaefer Gerald, Jones Carl D, Weibel Lisa, Denton Christopher P, Harper John I, Woo Patricia
Department of Rheumatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Skin Res Technol. 2009 Aug;15(3):346-56. doi: 10.1111/j.1600-0846.2009.00371.x.
BACKGROUND/PURPOSE: Localised scleroderma (LS) is the most common form of scleroderma seen in children, and usually presents unilaterally. Infrared thermography (IRT) and laser Doppler (LD) have both been reported to be useful in assessing the active, inflammatory stage of LS. We developed and validated a protocol using these techniques for the assessment of unilateral LS activity in children.
We investigated the spatial variability and repeatability of LD measurements from adult control forearm skin, and the inter- and intra-operator reproducibility of both LD blood flow trace analysis and IRT skin temperature analysis. Software was developed to produce overlay images of thermograms onto digital photographs of skin sites. In a group of seven adult control subjects, we established the normal range for skin temperature and LD blood flow at six standardised sites (forehead, cheek, abdomen, back, arm and leg), and measured contralateral differences in readings. In a group of 34 children with LS, we investigated the skin temperature and LD blood flow in unaffected skin at the same six sites.
In adults, physiological variability in LD blood flow and skin temperature between the two sides of the body was found to be greater than the uncertainty introduced into the measurements by (inter alia) limited intra- or inter-operator reproducibility. The cheek displayed the highest mean asymmetry in both skin temperature (0.5 degrees C) and LD blood flow (40%).
Our protocol combines IRT, LD and photography for LS assessment in children, and establishes a normal range of readings in line with other authors.
背景/目的：局限性硬皮病（LS）是儿童中最常见的硬皮病形式，通常单侧出现。据报道，红外热成像（IRT）和激光多普勒（LD）在评估LS的活动期和炎症期时均有用。我们开发并验证了一种使用这些技术评估儿童单侧LS活动的方案。
我们研究了成年对照者前臂皮肤LD测量的空间变异性和可重复性，以及LD血流轨迹分析和IRT皮肤温度分析在操作者之间和操作者内部的可重复性。开发了软件以生成热成像图覆盖在皮肤部位数码照片上的叠加图像。在一组7名成年对照者中，我们确定了六个标准化部位（额头、脸颊、腹部、背部、手臂和腿部）的皮肤温度和LD血流的正常范围，并测量了对侧读数差异。在一组34名患有LS的儿童中，我们研究了相同六个部位未受影响皮肤的皮肤温度和LD血流。
在成年人中，发现身体两侧LD血流和皮肤温度的生理变异性大于（尤其是）操作者内部或操作者之间有限的可重复性给测量带来的不确定性。脸颊在皮肤温度（0.5摄氏度）和LD血流（40%）方面均表现出最高的平均不对称性。
我们的方案结合了IRT、LD和摄影技术用于儿童LS的评估，并与其他作者一致建立了正常读数范围。
