title: Spoilt for choice--evaluation of two different scoring systems for early hand eczema in teledermatological examinations.
abstract: BACKGROUND
  Besides improving working conditions and using personal protective equipment, early detection is most important in managing work-related hand eczema. Implementing regular teledermatological skin screenings could be helpful, but none of the published hand eczema-scores has hitherto been used in teledermatology.
  
  
  OBJECTIVE
  Testing and comparing two validated scores [Osnabrück hand eczema severity index (OHSI); hand eczema severity index (HECSI)] for their suitability in an occupational telemedical screening.
  
  
  METHODS
  One hundred and twenty photographic records of the hands of 30 male wet workers were examined twice with each score. Results were tested for reproducibility, intra-observer reliability and inter-score-correlation.
  
  
  RESULTS
  Examination time, mean score values, and score ranges reached did not differ significantly. The inter-score-correlation was moderate (correlation coefficients: 0.651 for first examination; 0.642 for second examination). In the qualitative assessment, the HECSI showed a better overall agreement between results of first and second examinations.
  
  
  CONCLUSIONS
  Both scores are suitable for assessing the skin condition in a teledermatological setting. The comparability is limited to qualitative assessment, as the strictly objective OHSI measures the extent of hand eczema and the finer graduated HECSI measures the intensity of hand eczema, adding a subjective component. For assessing minimal skin changes, a scoring system that reduces subjective elements while at the same time it offers a differentiated grading is advisable.
authors.affiliation: Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany. Thomas.Baumeister@ipasum.med.uni-erlangen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Baumeister
authors.forename: Wobbeke
authors.initials: W
authors.lastname: Weistenhöfer
authors.forename: Hans
authors.initials: H
authors.lastname: Drexler
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kütting
mesh_terms: D000293:Adolescent; D000328:Adult; D009783:Dermatitis, Occupational / Q000473:pathology*; D004485:Eczema / Q000473:pathology*; D006229:Hand Dermatoses / Q000473:pathology*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010781:Photography; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D017216:Telemedicine
chemical_list: D008670:Metals