title: Instrumental assessment of atopic eczema: validation of transepidermal water loss, stratum corneum hydration, erythema, scaling, and edema.
abstract: BACKGROUND
  Quantification of skin diseases can be carried out in many ways. Clinical scores are widely used in atopic eczema (AE), and noninvasive instruments are a relevant supplement.
  
  
  OBJECTIVE
  Our purpose was to validate 5 noninvasive instruments in quantification of AE severity.
  
  
  METHODS
  In all, 101 patients with AE and 30 control subjects were assessed twice in a clinical cross-sectional examination. Assessment of transepidermal water loss, stratum corneum hydration, erythema, scaling, and subepidermal edema was assessed on 3 predetermined skin sites.
  
  
  RESULTS
  The methods discriminated among various severity degrees and correlated significantly with objective assessment of disease severity. High correlations were found among instruments assessing acute symptoms of AE. Threshold values for transepidermal water loss and capacitance were found.
  
  
  CONCLUSIONS
  No gold standard exists for severity assessment of atopic eczema. Therefore, the methods used cannot be validated in relation to such a standard. Furthermore, atopic eczema is a generalized disease and the methods used assess target lesions. By assessing target lesions, information about the disease is reduced.
  
  
  CONCLUSIONS
  Noninvasive instruments are valuable in quantification of disease severity in a mixed group of patients with active AE. Assessment with ultrasound has contributed new information about the pathophysiology in AE.
authors.affiliation: Department of Dermatology at Roskilde Hospital, Copenhagen University, Denmark. rselho@ra.dk
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Holm
authors.forename: Hans C
authors.initials: HC
authors.lastname: Wulf
authors.forename: Lars
authors.initials: L
authors.lastname: Thomassen
authors.forename: Gregor B E
authors.initials: GB
authors.lastname: Jemec
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001834:Body Water / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D004487:Edema / Q000209:etiology*; D025802:Electric Capacitance; D004817:Epidermis / Q000378:metabolism* / Q000473:pathology; D004890:Erythema / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014870:Water Loss, Insensible