title: A validated hand grading scale.
abstract: BACKGROUND
  Following the popularity of facial cosmetic procedures to reverse the signs of aging, cosmetic procedures that rejuvenate the hand are being sought. Irregular surface pigmentation, prominence of superficial veins and tendons, thinning of the dermis, and loss of subcutaneous fat typically characterize aging of the hand.
  
  
  OBJECTIVE
  To develop the Hand Grading Scale for objective quantification of the severity of hand aging and to establish the reliability of this photonumeric scale for clinical research and practice.
  
  
  METHODS
  The Hand Grading Scale is a 5-point photonumeric rating scale that was developed to objectively quantify the severity of aging of the hand. Nine experts rated photographs of 35 subjects, twice, with regard to the aspect "hand aging" in comparison with morphed images. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients.
  
  
  RESULTS
  The agreement between the experts was considerably high. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts.
  
  
  CONCLUSIONS
  The 5-point photonumeric scale generated spans the severity of hand aging for which patients most commonly seek correction. The scale is well stratified for consistent rating.
authors.affiliation: Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada. alastair@carruthers.net
authors.forename: Alastair
authors.initials: A
authors.lastname: Carruthers
authors.forename: Jean
authors.initials: J
authors.lastname: Carruthers
authors.forename: Bhushan
authors.initials: B
authors.lastname: Hardas
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kaur
authors.forename: Roman
authors.initials: R
authors.lastname: Goertelmeyer
authors.forename: Derek
authors.initials: D
authors.lastname: Jones
authors.forename: Berthold
authors.initials: B
authors.lastname: Rzany
authors.forename: Joel
authors.initials: J
authors.lastname: Cohen
authors.forename: Martina
authors.initials: M
authors.lastname: Kerscher
authors.forename: Timothy Corcoran
authors.initials: TC
authors.lastname: Flynn
authors.forename: Corey
authors.initials: C
authors.lastname: Maas
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sattler
authors.forename: Alexander
authors.initials: A
authors.lastname: Gebauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Pooth
authors.forename: Kathleen
authors.initials: K
authors.lastname: McClure
authors.forename: Ulli
authors.initials: U
authors.lastname: Simone-Korbel
authors.forename: Larry
authors.initials: L
authors.lastname: Buchner
mesh_terms: D004954:Esthetics / Q000145:classification*; D005260:Female; D006225:Hand / Q000033:anatomy & histology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D010781:Photography / Q000379:methods; D015203:Reproducibility of Results; D015595:Skin Aging