C C Zouboulis1,2, T Tzellos3, A Kyrgidis2, G B E Jemec4, F G Bechara5, E J Giamarellos-Bourboulis6, J R Ingram7, T Kanni6, I Karagiannidis1, A Martorell8, Ł Matusiak9, A Pinter10, E P Prens11, D Presser12, S Schneider-Burrus13,14, E von Stebut15, J C Szepietowski9, H H van der Zee11, S M Wilden15, R Sabat13. 1. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany. 2. Division of Evidence Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, University of Brandenburg, Dessau, Germany. 3. Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad, Troms, Norway. 4. Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. 5. Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Bochum, Germany. 6. 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 7. Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, U.K. 8. Department of Dermatology, Hospital de Manises, Valencia, Spain. 9. Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland. 10. Department of Dermatology, Venereology and Allergology, Goethe University of Frankfurt, Frankfurt am Main, Germany. 11. Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands. 12. Department of Dermatology, Venereology and Allergology, University Hospital of Würzburg, Würzburg, Germany. 13. Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 14. Centre of Vein and Skin Surgery, Havelkinik Berlin, Berlin, Germany. 15. Department of Dermatology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.
Abstract
BACKGROUND: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES: To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS: A Delphi voting procedure was conducted among the members of the European Hidradenitis Suppurativa Foundation (EHSF) to achieve consensus towards an initial HS Severity Score System (HS4). Strengths and weaknesses of HS4 were examined by a multicentre prospective study. Multivariate logistic regression, discriminant analysis and receiver operating characteristic curves, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS: Consensus HS4 was based on number of skin lesions, number of skin areas involved and Dermatology Life Quality Index (DLQI), and was evaluated by a sample of 236 patients from 11 centres. Subsequently, a multivariate regression model calculated adjusted odds ratios for several clinical signs. Nodules, abscesses and draining tunnels resulted as the scoring variables. Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4-10 signifies moderate and 11 or higher signifies severe disease. Cohen's kappa was fair (κ = 0·32) compared with Hurley classification, and moderate (κ = 0·49) compared with Expert Opinion. Correlation was good (ρ > 0·6) with Hurley classification, Expert Opinion, Physician's Global Assessment and Modified Sartorius score, and moderate for DLQI (ρ = 0·36). CONCLUSIONS: The novel IHS4 is a validated tool to dynamically assess HS severity and can be used both in real-life and the clinical trials setting.
BACKGROUND: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES: To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS: A Delphi voting procedure was conducted among the members of the European Hidradenitis Suppurativa Foundation (EHSF) to achieve consensus towards an initial HS Severity Score System (HS4). Strengths and weaknesses of HS4 were examined by a multicentre prospective study. Multivariate logistic regression, discriminant analysis and receiver operating characteristic curves, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS: Consensus HS4 was based on number of skin lesions, number of skin areas involved and Dermatology Life Quality Index (DLQI), and was evaluated by a sample of 236 patients from 11 centres. Subsequently, a multivariate regression model calculated adjusted odds ratios for several clinical signs. Nodules, abscesses and draining tunnels resulted as the scoring variables. Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4-10 signifies moderate and 11 or higher signifies severe disease. Cohen's kappa was fair (κ = 0·32) compared with Hurley classification, and moderate (κ = 0·49) compared with Expert Opinion. Correlation was good (ρ > 0·6) with Hurley classification, Expert Opinion, Physician's Global Assessment and Modified Sartorius score, and moderate for DLQI (ρ = 0·36). CONCLUSIONS: The novel IHS4 is a validated tool to dynamically assess HS severity and can be used both in real-life and the clinical trials setting.
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