Spoilt for choice – evaluation of two different scoring systems for early hand eczema in teledermatological examinations

Abstract

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. 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. 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. 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. 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.