RESUMEN
BACKGROUND: We propose that the distribution of skin lesions in psoriasis may be assessed using parametric maps on a pixel-by-pixel basis. MATERIAL AND METHODS: We processed 428 patient-drawn self-descriptions of the psoriasis lesions on a supplied body template. We compared 195 patients with a confirmed diagnosis of psoriatic arthritis (PsA) with 89 who had this diagnosis rejected (Psor). Additionally, 28 Psor cases supplied drawings performed after 3 weeks of climate therapy (PsorCT) to test the treatment efficacy. The drawings were scanned, lesion areas were segmented, followed by construction of parametric maps of lesion distributions and calculation of statistical differences between groups. RESULTS AND DISCUSSION: In PsorCT, the lesions occupied 11.2% (0-42%) [median (min.-max.)] of the body area. The area decreased to 2.4% (6-11%) after heliotherapy. The differences were statistically significant for all the areas studied and spread evenly over the body surface. PsA had a relatively low psoriasis lesion occupancy of 2.5% (0-42%) compared with Psor 9.8% (0-34%), which is attributed to the difference in recruitment. Correcting for this, we demonstrate a clear tendency for the head, palms, feet, groin and nails to be preferred lesion sites in PsA in contrast to psoriasis. CONCLUSION: Pixel-based analysis of self-reported skin lesion distributions is a powerful tool to assess systematic differences due to treatment or disease variants.
Asunto(s)
Artritis Psoriásica/patología , Superficie Corporal , Modelos Biológicos , Psoriasis/patología , Piel/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Dermatología/métodos , Humanos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: Primary focal hyperhidrosis is a hereditary condition characterized by excessive sweating affecting a variety of areas, including the palms. In most cases, the decision to treat a patient is based only on the patient's own description of the symptoms because laboratory tests have not been established in clinical practice. OBJECTIVE: To validate a subjective self-assessment scale for sweating in comparison with an objective method of quantifying evaporation from the skin surface. METHODS: We studied palmar sweating in 20 patients with primary focal hyperhidrosis and 20 age- and gender-matched controls. Four times in each subject, we obtained measurements of the evaporation in palms and the self-evaluation scale (SES) scores on a proportional scale from 0 (no sweating) to 10 (worst imaginable sweating). RESULTS: Good correlation was found between the SES score and evaporation assessment (R = .65). The SES score was easier to obtain and provided better diagnostic sensitivity and specificity. They leveled out at over 80% when a score of 3 was used as the threshold level; for evaporimetry, sensitivity equalled specificity at 70% at the threshold 90 mg -2h(-1). CONCLUSION: We confirm the usefulness of the SES in assessing palmar sweating and discuss the current restrictions in its use in clinical diagnosis. We propose that the scale can be added effortlessly to research or clinical protocols to provide the necessary validation in wider spectra of patients.