title: How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings.
abstract: BACKGROUND
  Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing.
  
  
  OBJECTIVE
  The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
  
  
  METHODS
  Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabrück hand eczema severity index, hand eczema severity index, Manuscore).
  
  
  RESULTS
  The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low.
  
  
  CONCLUSIONS
  The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.
authors.affiliation: Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, D-91054 Erlangen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Weistenhöfer
authors.forename: T
authors.initials: T
authors.lastname: Baumeister
authors.forename: H
authors.initials: H
authors.lastname: Drexler
authors.forename: B
authors.initials: B
authors.lastname: Kütting
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D009783:Dermatitis, Occupational / Q000473:pathology*; D004485:Eczema / Q000473:pathology* / Q000517:prevention & control; D005260:Female; D006229:Hand Dermatoses / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017132:Workplace; D055815:Young Adult