Comparison to estimate affected area and dosage of topical treatments in psoriasis

[Fred]

This study suggests a picture‐based method is the most advantages in terms of reliability, speed and user‐friendliness for the correct dosage of topical treatments.

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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.

Source: onlinelibrary.wiley.com

*Early view funding unknown