title: A new computerized method for the assessment of skin lesions in localized scleroderma.
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.
authors.affiliation: Department of Pediatrics, University of Padua, Italy. zulian@pediatria.unipd.it
authors.forename: F
authors.initials: F
authors.lastname: Zulian
authors.forename: D
authors.initials: D
authors.lastname: Meneghesso
authors.forename: E
authors.initials: E
authors.lastname: Grisan
authors.forename: F
authors.initials: F
authors.lastname: Vittadello
authors.forename: A
authors.initials: A
authors.lastname: Belloni Fortina
authors.forename: B
authors.initials: B
authors.lastname: Pigozzi
authors.forename: A C
authors.initials: AC
authors.lastname: Frigo
authors.forename: G
authors.initials: G
authors.lastname: Martini
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D015588:Observer Variation; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D012594:Scleroderma, Localized / Q000473:pathology*; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*