Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, D-91054 Erlangen, Germany.
Br J Dermatol. 2011 Apr;164(4):807-13. doi: 10.1111/j.1365-2133.2010.10181.x. Epub 2011 Mar 16.
Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing.
The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabrück hand eczema severity index, hand eczema severity index, Manuscore).
The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low.
The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.
皮肤评分系统需要根据其特定的设置和适应证满足特定的要求，例如职业筛查与临床检查、评估治疗进展或监督预防策略。到目前为止，大多数评分系统都是为严重的手部湿疹开发的。仍然缺乏针对早期手部湿疹的经过验证的定量评分系统。
本横断面研究旨在评估职业筛查（HEROS）中定量手部湿疹评分对手部湿疹的实际价值，以及其识别与工作相关的皮肤病风险增加个体的潜力。
对 800 名男性金属工人的双手进行检查，以评估手部皮炎的特征形态模式，并使用 HEROS 进行量化。通过对随机样本进行观察者间和观察者内可靠性测试来验证评分。验证结果与三种已验证的手部湿疹专用评分（奥斯纳布吕克手部湿疹严重指数、手部湿疹严重指数、Manuscore）进行了比较。
评分值范围为 0 至 82（理论最大值为 2260），反映了健康、适合工作的受试者的皮肤状况。观察者间和观察者内的可靠性均为良好至优秀。HEROS 的可靠性结果与手部湿疹的三种已验证评分一致。识别手部湿疹风险增加者的预测值较低。
HEROS 似乎是评估早期手部湿疹的观察者近独立评估的一种合适工具，尤其是用于量化最小的皮肤损伤。因此，我们建议在职业筛查中实施这种评分系统来量化早期手部皮炎。
