Digital photography as an operational tool for assessing corticosteroid-induced lipodystrophy.
BACKGROUND
Corticosteroid-induced lipodystrophy (CIL) is exclusively diagnosed in a subjective manner.


OBJECTIVE
To evaluate the reliability of digital photographs in the diagnosis of CIL.


METHODS
All consecutive patients starting long-term, high dosage corticosteroid therapy were photographed at baseline and after 3 months of therapy. At the end of the study, 3 physicians with expertise in corticosteroids classified patients as lipodystrophic yes/no/unclassifiable. Photographs analyses performed by 9 medical readers and evaluation of CIL using visual analog scale (VAS) performed during the M3 visit were compared to this classification.


RESULTS
Eighty-eight patients were monitored. Fifty of them were classified by the 3 experts as lipodystrophic and 30 as not lipodystrophic (8 were unclassifiable). Their intra- and inter-observer agreements were moderate or fair (kappa coefficient<or=0.57) when month 3 photographs were analysed alone and substantial or near perfect (kappa coefficient>or=0.75) when M3 photographs were analysed beside baseline ones. By comparison with expert consensus, only 3 out of 4 patients were correctly classified using VAS. The AUROC curve and inter-observer agreement significantly improved with experience for the 9 non-experts.


CONCLUSIONS
The use of digital photographs do better than VAS to evaluate CIL. The accuracy of diagnosis improves with experience. Morphological changes are more important than morphological phenotype.
Department of Internal Medicine, Hopital Saint-Antoine, 184 rue du Fbg Saint-Antoine, 75012 Paris, France. laurence.fardet@sat.aphp.fr
Laurence
L
Fardet
Adrien
A
Kettaneh
Kiet-Phong
KP
Tiev
Bénédicte
B
Fabre
Cécile
C
Tolédano
Jean
J
Cabane
Antoine
A
Flahault
D002983:Clinical Competence; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography / Q000295:instrumentation / Q000379:methods*; D011241:Prednisone / Q000009:adverse effects*; D015203:Reproducibility of Results
D005938:Glucocorticoids; D011241:Prednisone