Measurement of the severity of rosacea.
BACKGROUND
There are no standardized measures for the severity of rosacea.


OBJECTIVE
To determine what clinical signs correlate best with global severity of rosacea, and to examine inter-rater reliability. Methods Four clinicians each made 82 assessments of rosacea patients. Each assessment used 60 0-to-10 Likert-like scales for the signs of rosacea. Subjects also assessed the severity of their rosacea.


RESULTS
The clinicians' assessment of global severity correlated strongly with erythema, especially on the cheeks. Subjects' assessment of global severity correlated more strongly with papules/pustules. Different methods of assessing severity--estimation of area involved, intensity, or lesion counts--did not produce significantly different results. Inter-rater reliability was low on 11-point (0-10) scales, but improved when scales were collapsed to 5 or 4 points.


CONCLUSIONS
Clinicians and patients assess severity of rosacea differently, with clinicians focusing on erythema and patients focusing on papules/pustules. New instruments for assessing severity must address inter-rater reliability.
Bamford
Joel T M
JT
Department of Dermatology, St. Mary's/Duluth Clinic Health System, Duluth, MN 55805-1983, USA. jbamford@smdc.org
Gessert
Charles E
CE
Renier
Colleen M
CM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005148:Facial Dermatoses / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D012393:Rosacea / Q000175:diagnosis*; D012720:Severity of Illness Index