Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Schillerstr. 25 + 29, D-91054 Erlangen, Germany.
Br J Dermatol. 2010 Feb 1;162(2):239-50. doi: 10.1111/j.1365-2133.2009.09463.x. Epub 2009 Sep 28.
The present review gives an overview of the enormous variety of skin scores used for assessing severity in patients suffering from hand eczema. In order to evaluate the validity and practical relevance of different scoring systems according to the criteria of evidence-based medicine, in May 2009 we performed a systematic search of the literature using PubMed and the Cochrane Library. A total of 69 articles reporting on 45 different methods for quantifying hand eczema were identified. The panel of methods varied from pure subjective categories to more or less quantitative scoring systems. Furthermore, by focusing on skin scores used in clinical trials in which the results led to the licensing of a systemic or topical drug for treatment of hand eczema, a panel of different scoring systems was identified. In addition to morphological pattern, some scoring systems included subjective complaints, which might cause an individual bias by overestimation of self-reports. Inter- and intraobserver reliability was rarely reported except for three scores. Among these validated scores interobserver reliability was reported for three scores, but only one of the three included reliability within observers (repeatability). Advantages and disadvantages of the different scoring systems are critically discussed. Depending on different indications and particular settings (e.g. occupational screening vs. clinical examinations, evaluating progress of treatment in everyday clinical practice or for research purposes) scoring systems have to fulfil diverging demands. We draw the conclusion that a standardized diagnostic procedure for assessing the severity of hand eczema would facilitate the comparability of outcome of clinical trials. However, scoring systems used for occupational screening have to fulfil different demands compared with scoring systems used for licensing of drugs. This striking difference might be explained by the skin condition, which is generally supposed to be much better in subjects at medical check-ups at the workplace.
本综述概述了用于评估手部湿疹患者严重程度的大量皮肤评分方法。为了根据循证医学的标准评估不同评分系统的有效性和实际相关性，我们于 2009 年 5 月使用 PubMed 和 Cochrane 图书馆进行了系统的文献检索。共确定了 69 篇报道了 45 种不同量化手部湿疹方法的文章。方法的范围从纯主观类别到或多或少的定量评分系统不等。此外，通过关注导致系统或局部药物治疗手部湿疹许可的临床试验中使用的皮肤评分方法，确定了一组不同的评分系统。除了形态模式外，一些评分系统还包括主观投诉，这可能会因自我报告的高估而导致个体偏差。除了三个评分系统外，很少有报道过观察者之间和观察者内部的可靠性。在这些验证过的评分系统中，有三个评分系统报告了观察者之间的可靠性，但只有一个包括了观察者内部的可靠性（重复性）。批判性地讨论了不同评分系统的优缺点。根据不同的适应症和特定设置（例如职业筛查与临床检查、评估日常临床实践中的治疗进展或研究目的），评分系统必须满足不同的需求。我们得出结论，标准化的手部湿疹严重程度评估诊断程序将有助于临床试验结果的可比性。然而，用于职业筛查的评分系统与用于药物许可的评分系统相比，必须满足不同的需求。这种明显的差异可以用皮肤状况来解释，在工作场所的医学检查中，皮肤状况通常被认为要好得多。
