title: Validation of a protocol for the assessment of skin temperature and blood flow in childhood localised scleroderma.
abstract: OBJECTIVE
  Localised scleroderma (LS) is the most common form of scleroderma seen in children, and usually presents unilaterally. Infrared thermography (IRT) and laser Doppler (LD) have both been reported to be useful in assessing the active, inflammatory stage of LS. We developed and validated a protocol using these techniques for the assessment of unilateral LS activity in children.
  
  
  METHODS
  We investigated the spatial variability and repeatability of LD measurements from adult control forearm skin, and the inter- and intra-operator reproducibility of both LD blood flow trace analysis and IRT skin temperature analysis. Software was developed to produce overlay images of thermograms onto digital photographs of skin sites. In a group of seven adult control subjects, we established the normal range for skin temperature and LD blood flow at six standardised sites (forehead, cheek, abdomen, back, arm and leg), and measured contralateral differences in readings. In a group of 34 children with LS, we investigated the skin temperature and LD blood flow in unaffected skin at the same six sites.
  
  
  RESULTS
  In adults, physiological variability in LD blood flow and skin temperature between the two sides of the body was found to be greater than the uncertainty introduced into the measurements by (inter alia) limited intra- or inter-operator reproducibility. The cheek displayed the highest mean asymmetry in both skin temperature (0.5 degrees C) and LD blood flow (40%).
  
  
  CONCLUSIONS
  Our protocol combines IRT, LD and photography for LS assessment in children, and establishes a normal range of readings in line with other authors.
authors.affiliation: Department of Rheumatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK. k.howell@medsch.ucl.ac.uk
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Howell
authors.forename: Antonia
authors.initials: A
authors.lastname: Lavorato
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Visentin
authors.forename: Roy E
authors.initials: RE
authors.lastname: Smith
authors.forename: Gerald
authors.initials: G
authors.lastname: Schaefer
authors.forename: Carl D
authors.initials: CD
authors.lastname: Jones
authors.forename: Lisa
authors.initials: L
authors.lastname: Weibel
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Denton
authors.forename: John I
authors.initials: JI
authors.lastname: Harper
authors.forename: Patricia
authors.initials: P
authors.lastname: Woo
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D045743:Scleroderma, Diffuse / Q000175:diagnosis* / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D012867:Skin / Q000503:physiopathology*; D012881:Skin Temperature; D013817:Thermography / Q000379:methods*; D055815:Young Adult