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Rheumatology Advance Access originally published online on January 30, 2007
Rheumatology 2007 46(5):856-860; doi:10.1093/rheumatology/kel446
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A new computerized method for the assessment of skin lesions in localized scleroderma

F. Zulian1, D. Meneghesso1, E. Grisan2, F. Vittadello1, A. Belloni Fortina1,3, B. Pigozzi1,3, A. C. Frigo4, G. Martini1 and A. Ruggeri2

1Department of Pediatrics, 2Department of Information Engineering, 3Department of Dermatology and 4Department of Environmental Medicine and Public Health, University of Padua, Italy.

Correspondence to: F. Zulian, MD, Dipartimento di Pediatria, Università di Padova, Via Giustiniani 3, 35128 Padova, Italy. E-mail: zulian{at}pediatria.unipd.it


  Abstract

Objective. Up to now, no validated tools are in use for the assessment of the skin lesions in localized scleroderma (LS). The aim of this study is to evaluate the performance of a new computerized skin score (CSS) method for the measurement of circumscribed lesions in LS.

Methods. The study consisted of three phases: set up of the CSS technique, measurement of target lesions of LS patients, assessment of intra- and inter-rater reliability. The CSS technique consists in delimitating the indurate lesion on an adhesive transparent film, transferring it over a cardboard and then calculating the affected area with a specifically created software.

The technique was explained to a panel of 10 physicians with different expertise in LS (three paediatric rheumatologists, two dermatologists, five paediatric residents). All participants, singularly and blindly to the others, examined 10 consecutive patients twice after a time interval of at least 6 h. The intra-observer variability was evaluated by the repeatability coefficient and the inter-rater reliability by the intra-class correlation coefficient (ICC).

Results. The repeatability coefficients were good, ranging between 1.90 and 7.03. The mean values of skin scores were not significantly different among the examiners. The ICC for indurate area calculation were high in both the experts (0.97) and the residents (0.91–0.94).

Conclusions. CSS has shown to be a reliable method to assess the skin lesions in patients with LS. It is reproducible, easy to use and, with the support of the CSS software, applicable worldwide.

KEY WORDS: Localized scleroderma, Morphoea, Scleroderma en coup de sabre, Computerized skin score, Outcome measure

Submitted 12 October 2006; revised version accepted 12 December 2006.
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