Zhao C Y, Wijayanti A, Doria M C, Harris A G, Jain S V, Legaspi K N, Dlova N C, Law M G, Murrell D F
Department of Dermatology, St. George Hospital, Sydney, Australia.
Faculty of Medicine, University of New South Wales, Sydney, Australia.
Int J Womens Dermatol. 2015 Aug 6;1(3):150-154. doi: 10.1016/j.ijwd.2015.05.002. eCollection 2015 Aug.
Outcome measures for atopic dermatitis (AD) patients with pigmented skin have neither been developed nor validated.
To compare the reliability and validity of four common AD outcome measures in patients with various levels of skin darkness.
The inter- and intra-rater reliability and construct validity of the EASI (Eczema Area and Severity Index), objective-SCORing Atopic Dermatitis (oSCORAD), Three Items Severity index (TIS) and Six Areas, Six Sites Atopic Dermatitis (SASSAD) were evaluated in 18 patients of various levels of skin darkness, using their full body photographs, by five trained clinicians.
The inter-rater reliability intraclass coefficient (ICCs) and 95% confidence intervals were poor for highly pigmented patients: EASI -.054(-.200 to .657), oSCORAD -.089(-.206 to .598), TIS -.21(-.24 to .147), SASSAD -.071(-.200 to .631); fair for mildly pigmented patients: EASI .464(.140-.839), oSCORAD .588(.265-.89), TIS.524(.200-.865), SASSAD .41(.045-.775); and fair to good for non-pigmented patients: EASI .64(.330-.908), oSCORAD .586(.263-.889), TIS .403(.09-.809), SASSAD .667(.358-.916). Erythema likely contributed to the inter-rater variability. Construct validity had significant correlations across all measures in non-pigmented patients, but no correlations in highly pigmented patients.
AD outcome measures have poor reliability and validity in highly pigmented patients, with variations in erythema perception being a contributor.
针对色素沉着皮肤的特应性皮炎(AD)患者,尚未开发和验证其疗效评估指标。
比较四种常用的AD疗效评估指标在不同皮肤色素沉着程度患者中的可靠性和有效性。
由五名经过培训的临床医生,根据18名不同皮肤色素沉着程度患者的全身照片,评估湿疹面积及严重程度指数(EASI)、特应性皮炎客观评分(oSCORAD)、三项严重程度指数(TIS)和六区域、六部位特应性皮炎(SASSAD)的评分者间信度、评分者内信度和结构效度。
对于色素沉着严重的患者,评分者间信度组内相关系数(ICC)及95%置信区间较差:EASI为-.054(-.200至.657),oSCORAD为-.089(-.206至.598),TIS为-.21(-.24至.147),SASSAD为-.071(-.200至.631);对于色素沉着轻度的患者,信度为中等:EASI为.464(.140至.839),oSCORAD为.588(.265至.89),TIS为.524(.200至.865),SASSAD为.41(.045至.775);对于无色素沉着的患者,信度为中等至良好:EASI为.64(.330至.908),oSCORAD为.586(.263至.889),TIS为.403(.09至.809),SASSAD为.667(.358至.916)。红斑可能导致了评分者间的变异性。在无色素沉着的患者中,所有指标的结构效度均存在显著相关性,但在色素沉着严重的患者中无相关性。
AD疗效评估指标在色素沉着严重的患者中可靠性和有效性较差,红斑感知差异是一个影响因素。