title: Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis.
abstract: BACKGROUND
  A standardized instrument is needed to rate the overall severity of chronic hand dermatitis (CHD), in particular during clinical trials.
  
  
  OBJECTIVE
  To design and validate a photographic guide.
  
  
  METHODS
  Initially, five experts were asked to grade 50 photographs of CHD, first individually, then as a consensus-building group, in order to select the photographs included in the guide. Then, a validation session with 11 different dermatologists evaluating 28 patients was conducted to assess the interrater reliability and test-retest reproducibility of the assessment of disease severity, relying on the photographic guide, on two consecutive days. Patient order was randomized, and only diseased hands were visible to prevent any bias in evaluation.
  
  
  RESULTS
  The experts reached a consensus for development of a photographic guide composed of five severity levels and four photographs per severity level. Results of the validation session showed a high level of interrater reliability and test-retest reproducibility.
  
  
  CONCLUSIONS
  The photographic guide is a reliable tool for assessing the morphological severity of hand dermatitis, and can be used as part of a comprehensive evaluation of disease in international multicentre clinical trials.
authors.affiliation: Rijnstate Hospital, 6815 AB Arnhem, the Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Coenraads
authors.forename: H
authors.initials: H
authors.lastname: Van Der Walle
authors.forename: K
authors.initials: K
authors.lastname: Thestrup-Pedersen
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: B
authors.initials: B
authors.lastname: Dreno
authors.forename: C
authors.initials: C
authors.lastname: De La Loge
authors.forename: M
authors.initials: M
authors.lastname: Viala
authors.forename: S
authors.initials: S
authors.lastname: Querner
authors.forename: T
authors.initials: T
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Zultak
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006229:Hand Dermatoses / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography; D015203:Reproducibility of Results; D012720:Severity of Illness Index