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.
Fardet
Laurence
L
Department of Internal Medicine, Hopital Saint-Antoine, 184 rue du Fbg Saint-Antoine, 75012 Paris, France. laurence.fardet@sat.aphp.fr
Kettaneh
Adrien
A
Tiev
Kiet-Phong
KP
Fabre
Bénédicte
B
Tolédano
Cécile
C
Cabane
Jean
J
Flahault
Antoine
A
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