Background: There is a lack of consensus as to the best way of monitoring psoriasis severity in clinical trials. The Psoriasis Area and Severity Index (PASI) is the most frequently used system and the Physician’s Glo...Background: There is a lack of consensus as to the best way of monitoring psoriasis severity in clinical trials. The Psoriasis Area and Severity Index (PASI) is the most frequently used system and the Physician’s Global Assessment (PGA) is also often used. However, both instruments have some drawbacks and neither has been fully evaluated in terms of ‘validity’and ‘reliability’as a psoriasis rating scale. The Lattice System Physician’s Global Assessment (LS-PGA) scale has recently been developed to address some disadvantages of the PASI and PGA. Objectives: To evaluate the inter-rater and intra rater reliability of the PASI, PGA and LS-PGA. Methods: On the day before the study, 14 dermatologists (raters), with varied experience of assessing psoriasis, received detailed training (2.5 h) on use of the scales. On the study day, each rater evaluated 16 adults with chronic plaque psoriasis in the morning and again in the afternoon. Raters were randomly assigned to assess subjects using the scales in a specific sequence, either PGA, LS-PGA, PASI or PGA, PASI, LS-PGA. Each rater used one sequence in the morning and the other in the afternoon. The primary endpoint was the inter-rater and intrarater reliability as determined by intraclass correlation coefficients (ICCs). Results: All three scales demonstrated ‘substantial’(a priori defined as ICC > 80%) intrarater reliability. The inter-rater reliability for each of the PASI and LS-PGA was also ‘substantial’and for the PGA was ‘moderate’(ICC 75%). Conclusions: Each one of the three scales provided reproducible psoriasis severity assessments. In terms of both intrarater and inter-rater reliability values, the three scales can be ranked from highest to lowest as follows: PASI, LS-PGA and PGA.展开更多
The inflammation which follows cryotherapy is a significant disadvantage of th is therapeutic modality. To date, the only treatment shown to reduce this inflam mation is application of topical corticoids. We have ther...The inflammation which follows cryotherapy is a significant disadvantage of th is therapeutic modality. To date, the only treatment shown to reduce this inflam mation is application of topical corticoids. We have therefore conducted a pilot study to investigate whether pretreatment with the free radical scavengers, vit amins C and E might alleviate the signs and symptoms of inflammation following l iquid nitrogen cryotherapy of common warts. We undertook a randomized, double-b lind, placebo-controlled, parallel group study. We recruited 40 adult patients, of whom 38 returned for evaluation. Treatments comprised vitamin C (2000 mg) an d vitamin E (800 IU) daily or matching placebo for 7 days prior to cryotherapy t o a hand wart. Oedema volume, erythema level, pain intensity and the presence or absence of blistering were assessed 24 h after cryotherapy. There were no signi ficant differences between the two treatment groups in any of the parameters ass essed. This study yielded no suggestion of benefit from the use of pretreatment with free radical scavengers in conjunction with liquid nitrogen cryotherapy.展开更多
文摘Background: There is a lack of consensus as to the best way of monitoring psoriasis severity in clinical trials. The Psoriasis Area and Severity Index (PASI) is the most frequently used system and the Physician’s Global Assessment (PGA) is also often used. However, both instruments have some drawbacks and neither has been fully evaluated in terms of ‘validity’and ‘reliability’as a psoriasis rating scale. The Lattice System Physician’s Global Assessment (LS-PGA) scale has recently been developed to address some disadvantages of the PASI and PGA. Objectives: To evaluate the inter-rater and intra rater reliability of the PASI, PGA and LS-PGA. Methods: On the day before the study, 14 dermatologists (raters), with varied experience of assessing psoriasis, received detailed training (2.5 h) on use of the scales. On the study day, each rater evaluated 16 adults with chronic plaque psoriasis in the morning and again in the afternoon. Raters were randomly assigned to assess subjects using the scales in a specific sequence, either PGA, LS-PGA, PASI or PGA, PASI, LS-PGA. Each rater used one sequence in the morning and the other in the afternoon. The primary endpoint was the inter-rater and intrarater reliability as determined by intraclass correlation coefficients (ICCs). Results: All three scales demonstrated ‘substantial’(a priori defined as ICC > 80%) intrarater reliability. The inter-rater reliability for each of the PASI and LS-PGA was also ‘substantial’and for the PGA was ‘moderate’(ICC 75%). Conclusions: Each one of the three scales provided reproducible psoriasis severity assessments. In terms of both intrarater and inter-rater reliability values, the three scales can be ranked from highest to lowest as follows: PASI, LS-PGA and PGA.
文摘The inflammation which follows cryotherapy is a significant disadvantage of th is therapeutic modality. To date, the only treatment shown to reduce this inflam mation is application of topical corticoids. We have therefore conducted a pilot study to investigate whether pretreatment with the free radical scavengers, vit amins C and E might alleviate the signs and symptoms of inflammation following l iquid nitrogen cryotherapy of common warts. We undertook a randomized, double-b lind, placebo-controlled, parallel group study. We recruited 40 adult patients, of whom 38 returned for evaluation. Treatments comprised vitamin C (2000 mg) an d vitamin E (800 IU) daily or matching placebo for 7 days prior to cryotherapy t o a hand wart. Oedema volume, erythema level, pain intensity and the presence or absence of blistering were assessed 24 h after cryotherapy. There were no signi ficant differences between the two treatment groups in any of the parameters ass essed. This study yielded no suggestion of benefit from the use of pretreatment with free radical scavengers in conjunction with liquid nitrogen cryotherapy.
