Conflicts of interest J. S. C. E. has acted as a paid consultant to Basilea, the manufacturer of alitretinoin.
Measure the extent of hand eczema rather than its severity?
Version of Record online: 24 JUN 2011
© 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011
British Journal of Dermatology
Volume 165, Issue 1, page 1, July 2011
How to Cite
English, J. S. C. (2011), Measure the extent of hand eczema rather than its severity?. British Journal of Dermatology, 165: 1. doi: 10.1111/j.1365-2133.2011.10423.x
- Issue online: 24 JUN 2011
- Version of Record online: 24 JUN 2011
Original Article, p123
Hand eczema is a common and frequently very debilitating disease.1,2 Managing it is not always simple and straightforward.3,4 The aetiology is often multifactorial with the commonest occupational cause in the U.K. being irritant contact dermatitis from frequent and excessive hand washing in health care professionals.5 There is enormous variation in the clinical presentation of hand eczema, which has been hampered until recently by no satisfactory classification system.6 In the past 10 years there has been greater interest and research in hand eczema through the development and licensing of the retinoid alitretinoin for chronic hand eczema.7 There are now many methods of assessing hand eczema and in this world where evidence-based medicine has increasing importance it is essential to have well-validated methods of assessment.8 Unfortunately there is at present no consensus as to how best to achieve self-assessment or score hand eczema. Some of the scores are designed for occupational contact dermatitis and others for clinical trials. Most of the scores have not been thoroughly validated or compared against each other.
However, a relatively simple method for scoring of hand eczema by patients and dermatological nurses using the Hand Eczema Extent Score (HEES) is published in this issue.9 The advantage of the HEES is that it looks at extent rather than severity as extent of hand eczema is linked to prognosis more than severity.10 This scoring method simply documents the extent of the hand eczema. It is easy and relatively quick to do in the clinic and may prove a useful tool for monitoring hand eczema over time. The study shows us that there is good correlation in scores between dermatologists (the gold standard), nurses and the patients themselves. There was an interclass correlation (ICC) of 0·61 between patient and dermatologist for the total score and the ICC between nurse and dermatologist was 0·78. So it would not be unreasonable for nurse specialists or the patients to score the extent serially when monitoring treatment. I appreciate that the authors have not studied in this paper the content or construct validity of this score but none the less because of its simplicity it will probably be a more useful measure for use in hand eczema clinical trials and routine clinical practice than many of the others currently available.