MedWire News: Researchers have developed a hand eczema score for occupational screenings (HEROS) showing excellent reliability for assessment of early hand eczema.
"Most methods for assessing hand eczema have been developed for severe cases and not for early forms. Until now, there has been no validated quantitative scoring system for early hand eczema," say Birgitta Kütting (University of Erlangen-Nuremberg, Germany) and co-authors.
The hands of 800 healthy male metal factory workers (aged 18-62 years) were examined for dermatitis, which was quantified with HEROS. To assess the extent of disease, each hand was subdivided into 54 areas; predominantly affected locations (eg, interdigital areas and knuckles) were defined as separate areas.
"Based on the broad range and the subdivision of each hand into numerous very small almost equal-sized areas, the HEROS seems to be precise enough to determine distribution as well as extent of disease," say the researchers.
Morphological patterns were subdivided into primary and secondary eruptions, with the severity of each pattern within a predefined area scoring from 0 (absent) to 3 (severe). Lichenification was given a score range of 0-2.
Following validation of HEROS by testing inter- and intra-observer reliability, results were then compared with the Osnabrück hand eczema severity index (OSHI), the hand eczema severity index (HECSI), and Manuscore.
Of a maximum value of 2260, score values on HEROS ranged from 0 to 82, reflecting the skin condition of healthy, fit-for-work individuals with moderate hand dermatitis at worst. Indeed, 84.8% of workers were considered to have mild skin lesions, with moderate skin lesions observed in only 2.6% of individuals.
Dermatological examinations with HEROS took, on average, less than 3 minutes per individual, providing comparable timings to the validated OSHI and HECSI measures.
Results for the reliability of HEROS in assessing early hand eczema were in line with the three validated scores for distinct hand eczema, indicating good-to-excellent inter- and intra-observer variability.
However, the predictive value of HEROS for identifying those at increased risk for developing hand eczema was low and results revealed the worst agreement in the most severe cases.
Writing in the British Journal of Dermatology, the researchers conclude: "Based on its good-to-excellent inter-and intra-observer reliability in patients with mild hand eczema, this score should be implemented in occupational screenings."
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