The durometry in the assessment of psoriasis plate, an exploratory study
DOI:
https://doi.org/10.29176/2590843X.426Keywords:
Psoriasis, plaque, induration, hardnessAbstract
Background: Psoriasis biomechanically exhibits changes in the hardness of the skin; there are no markers to measure their activity and their follow-up is based on clinimetry. One of the deficiencies of the PASI is the interdependence between its variables and the controversy when defining the "induration" of the plate, either from its height or from semiology. The durometer, an apparatus that measures the hardness of materials, was tested for the first time to measure this characteristic.
Methods: Two evaluators (E1 and E2) with a factory calibrated durometer, measured in hardness units both plaques and "healthy" skin control. The analysis was performed using Student's t-test and ANOVA for paired groups with repeated measures, Pearson's correlation coefficient (r), Fisher's variance (F) and correlation and agreement using linear regression and Kappa index.
Results and conclusions: Thirty-three plaques were obtained from 13 patients with average PASI of 11. E1 and E2 obtained r=0.37 and 0.22 between the durometry vs. IndPASI. An F>20 between plates vs. healthy skin; Inter-rater an r=0.95, and a kappa index of 0.88 with 95%CI and p<0.05. Durometry does not correlate with PASI. However, a recalibration in its function is feasible, requiring more studies with a larger sample, analyzing the effects of the therapeutic scheme over time. The durometry is useful in the assessment of the hardness of the psoriasis plaque, with adequate correlation and inter-rater agreement.
Author Biographies
Jhonatan Quintero
Médico cirujano, residente de tercer año de Dermatología, Universidad de Caldas, Manizales, Colombia
Felipe Jaramillo-Ayerbe
Médico cirujano, dermatólogo, dermatopatólogo; jefe, Programa de Dermatología, Universidad de Caldas, Manizales, Colombia
Ana María Hoyos
Médica cirujana, dermatóloga, Universidad de Caldas, docente, Programa de Dermatología, Universidad de Caldas, Manizales, Colombia
José Arnoby Chacón
Médico, MSP; profesor, Universidad de Caldas, Manizales, Colombia
References
Boehncke WH. Etiology and pathogenesis of psoriasis. Rheum Dis Clin North Am. 2015;41:665-75.
https://doi.org/10.1016/j.rdc.2015.07.013
Boehncke WH, Schon MP. Psoriasis. Lancet. 2015;386:983-94.
https://doi.org/10.1016/S0140-6736(14)61909-7
Chalela J, González C, Castro L. Guías de manejo de psoriasis: consenso colombiano. Bogotá: Asociación Colombiana de Dermatología y Cirugía Dermatológica; 2008.
González C, Londoño A, Castro L. Guías basadas en la evidencia para el manejo de la psoriasis en Colombia. Bogotá: Editorial Panamericana; 2012. p. 23-67.
Kim J, Nadella P, Kim DJ, Brodmerkel C, Correa da Rosa JC, Krueger JG, et al. Histological stratification of thick and thin plaque psoriasis explores molecular phenotypes with clinical implications. PLoS One. 2015;10:e0132454.
https://doi.org/10.1371/journal.pone.0132454
Naldi L, Gambini D. The clinical spectrum of psoriasis. Clin Dematol. 2007;25:510-8.
https://doi.org/10.1016/j.clindermatol.2007.08.003
González C, Castro L, De La Cruz G, Arenas CM, Beltrán A, Santos AM. Caracterización epidemiológica de la psoriasis en el Hospital Militar Central. Rev Asoc Col Dermatol. 2009;17:11-7.
Hoffmann K, Dirschka T, Schwarze H, el-Gammal S, Matthes U, Hoffmann A, et al. 20 MHz sonography, colorimetry and image analysis in the evaluation of psoriasis vulgaris. J Dermatol Sci. 1995;9:103-10.
https://doi.org/10.1016/0923-1811(94)00358-L
Hamilton M, Ntais D, Griffiths C, Davies L. Psoriasis treatment and management - a systematic review of full economic evaluations. Br J Dermatol. 2015;172:574-83.
https://doi.org/10.1111/bjd.13486
National Clinical Guideline Centre. Psoriasis: Assessment and management of psoriasis. London: Royal College of Physicians; 2012.
PASI Training. A comprehensive training gude to Psoriasis Area Severity index http://www.pasitraining.com/calculator/step_1.php.
Alfonso-Trujillo I, Díaz-García MA, Rodríguez-García MA, Torres-Gemeil O, Falcón-Lincheta L, Pérez-Hernández M, et al. Psoriasis. Glosario para ensayos clínicos. Dermatol Peru. 2007;17:40-3.
Kissin EY, Schiller AM, Gelbard RB, Anderson JJ, Falanga V, Simms RW, et al. Durometry for the assessment of skin disease in systemic sclerosis. Arthritis Rheum. 2006;55:603-9.
https://doi.org/10.1002/art.22093
Choh CT, Wall ML, Brown MD, Nicolson AM, Simms MH. Use of durometry in assessment of venous disease. Phlebology. 2010;25:94-9.
https://doi.org/10.1258/phleb.2009.008088
Falanga V, Bucalo B. Use of a durometer to assess skin hardness. J Am Acad Dermatol. 1993;29:47-51.
https://doi.org/10.1016/0190-9622(93)70150-R
Mcgraw C, Alexander E Jr. Durometer for measurement of intracranial pressure. Surg Neurol. 1977;7:293-5.
Sideris DA, Harocopos FS, Karamitsos CB, Moulopoulos SD. Direct measurement of myocadial hardness. Eur J Cardiol. 1978;7:59-70.
Belyaev O, Herden H, Meier JJ, Muller CA, Seelig MH, Herzog T, et al. Assessment of pancreatic hardness -surgeon versus durometer. J Surg Res. 2010;158:53-60.
https://doi.org/10.1016/j.jss.2008.08.022
Leblanc N, Falabella A, Murata H, Hasan A, Weiss E, Falanga V. Durometer measurements of skin induration in venous disease. Dermatol Surg. 1997;23:285-7.
https://doi.org/10.1111/j.1524-4725.1997.tb00046.x
Seyger MM, van den Hoogen FH, de Boo T, de Jong EM. Reliability of two methods to assess morphea: skin scoring and the use of a durometer. J Am Acad Dermatol. 1997;37:793-6.
https://doi.org/10.1016/S0190-9622(97)70121-X
Poff S, Li SC, Kelsey CE, Foeldvari I, Torok KS. Durometry as an outcome measure in juvenile localized scleroderma. Br J Dermatol. 2016;174:228-30.
https://doi.org/10.1111/bjd.14103
Merkel PA, Silliman NP, Denton CP, Furst DE, Khanna D, Emery P, et al. Validity, reliability, and feasibility of durometer measurements of scleroderma skin disease in a multicenter treatment trial. Arthritis Rheum. 2008;59:699-705.
https://doi.org/10.1002/art.23564
John OP, Benet-Martínez V. Measurement: Reliability, construct validation, and scale construction. In: Reis HT, Judd CM, editors. Handbook of research methods in social and personality psychology. New York: Cambridge University. Press; 2000. p. 339-69.
Aghassi D, Monoson T, Braverman I. Reproducible measurements to quantify cutaneous involvement in scleroderma. Arch Dermatol. 1995;131:1160-6.
https://doi.org/10.1001/archderm.1995.01690220066013
Naldi L. Scoring and monitoring the severity of psoriasis. What is the preferred method? What is the ideal method? Is PASI passé? Facts and controversies. Clin Dermatol. 2010;28:67-72
https://doi.org/10.1016/j.clindermatol.2009.03.001
Purzycka-Bohdan D, Szczerkowska-Dobosz A, Zablotna M, Wierzbicka J, Piotrowska A, Zmijewski MA, et al. Assessment of interleukin 16 serum levels and skin expression in psoriasis patients in correlation with clinical severity of the disease. PLoS One. 2016;11:e0165577.
https://doi.org/10.1371/journal.pone.0165577
Okan G, Baki AM, Yorulmaz E, Doğru-Abbasoğlu S, Vural P. Fibroblast growth factor 23 and placental growth factor in patients with psoriasis and their relation to disease severity. Ann Clin Lab Sci. 2016;46:174-9.
Rutter KJ, Watson RE, Cotterell LF, Brenn T, Griffiths CE, Rhodes LE. Severely photosensitive psoriasis: a phenotypically defined patient subset. J Invest Dermatol. 2009;129:2861-7.
https://doi.org/10.1038/jid.2009.156
Musumeci ML, Lacarrubba F, Fusto CM, Micali G. Combined clinical, capillaroscopy and ultrasound evaluation during treatment of plaque psoriasis with oral cyclosporine. Int J Immunopathol Pharmacol. 2013;26:1027-33.
https://doi.org/10.1177/039463201302600425
Zafar H, Enfield J, O'Connell ML, Ramsay B, Lynch M, Leahy M. Assessment of psoriatic plaque in vivo with correlation mapping optical coherence tomography. Skin Res Technol. 2014;20:141-6.
https://doi.org/10.1111/srt.12096
Shrivastava VK, Londhe ND, Sonawane RS, Suri JS. First review on psoriasis severity risk stratification: An engineering perspective. Comput Biol Med. 2015;63:52-63.
https://doi.org/10.1016/j.compbiomed.2015.05.005
Dobrev H. In vivo study of skin mechanical properties in psoriasis vulgaris. Acta Derm Venereol. 2000;80:263-6.
https://doi.org/10.1080/000155500750012135
Choi JW, Kwon SH, Youn JI, Youn SW. Objective measurements of erythema, elasticity and scale could overcome the inter- and intra-observer variations of subjective evaluations for psoriasis severity. Eur J Dermatol. 2013;23:224-9.
https://doi.org/10.1684/ejd.2013.1931
Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010;34:J314-21.
https://doi.org/10.1016/j.jaut.2009.12.001
Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J Invest Dermatol. 2013;133:377-85.
How to Cite
Downloads
Downloads
Published
How to Cite
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
