Background: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). Objectives: To develop and validate a scoring system called the ...Background: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). Objectives: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Methods: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. Results: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment, ICC for intraobserver agreement was 0.90. Conclusions: Overall excellent agreement existed for both inter-and intra-observer reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.展开更多
Background: The rapidly increasing level of contact allergy to methyldibromog lutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, ...Background: The rapidly increasing level of contact allergy to methyldibromog lutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50- 100 p.p.m. Objectives: To determi ne whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized indi viduals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content. Methods: Eighteen volunteerswith contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with t wo moisturizers with a high and a low lipid content, respectively, both containi ng MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left an d the right side of the neck for 14 days, or until a positive re action was seen. If a positive reaction did not develop within the first 14 d ays, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a f urther 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed. Results: Eleven of 18 (61% ) subjects developed der matitis on the test area, of whom 10 developed a positive reaction to the 50 p.p .m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to th e low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs. Conclusions: Even 50 p.p.m. cannot be regarded as a safe con centration for use and the prohibition of MDBGN is scientifically well founded.展开更多
文摘Background: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). Objectives: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Methods: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. Results: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment, ICC for intraobserver agreement was 0.90. Conclusions: Overall excellent agreement existed for both inter-and intra-observer reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.
文摘Background: The rapidly increasing level of contact allergy to methyldibromog lutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50- 100 p.p.m. Objectives: To determi ne whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized indi viduals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content. Methods: Eighteen volunteerswith contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with t wo moisturizers with a high and a low lipid content, respectively, both containi ng MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left an d the right side of the neck for 14 days, or until a positive re action was seen. If a positive reaction did not develop within the first 14 d ays, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a f urther 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed. Results: Eleven of 18 (61% ) subjects developed der matitis on the test area, of whom 10 developed a positive reaction to the 50 p.p .m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to th e low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs. Conclusions: Even 50 p.p.m. cannot be regarded as a safe con centration for use and the prohibition of MDBGN is scientifically well founded.
