Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case–control diagnostic accuracy study (DIPSOC study)*
“…All diagnostic criteria should be developed using a clear and explicit methodology and replicated in independent studies. The methods used may progress over time from simple consensus 30 to epidemiological approaches 19 . The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful.•Diagnostic criteria are only guides in clinical practice whereas they are essential for research purposes so that similar groups can be compared.•Skin diseases can be defined by various approaches, ranging from simple consensus to case–control and cluster analysis methods.•Consensus criteria for a skin disease run the risk of determining the ‘eternal truth’ by a show of hands, and need to be revisited periodically in the light of new evidence.•Skin disease definitions must have demonstrable validity and applicability to a range of people of different ages, sex/genders and ethnicities.•The trade‐off between sensitivity and specificity of diagnostic criteria will vary according to their purpose.•Skin diseases should not be split prematurely on epiphenomena unless the new divisions are shown to be stable and useful for clinical and research purposes.…”
Section: Discussionmentioning
confidence: 99%
“…The methods used may progress over time from simple consensus 30 to epidemiological approaches. 19 The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful.…”
Section: Discussionmentioning
confidence: 99%
“…The methods used may progress over time from simple consensus 30 to epidemiological approaches. 19 The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful. Learning points Diagnostic criteria are only guides in clinical practice whereas they are essential for research purposes so that similar groups can be compared.…”
Section: Discussionmentioning
confidence: 99%
“…Using a case–control approach, the frequency, validity and reliability of symptoms and signs of AD in typical cases and controls with other skin diseases were evaluated in a blinded fashion 16–18 (Table 2). Other researchers have used similar methodological approaches successfully 19 …”
Section: Diverse Approaches That Can Be Used For Defining Skin Diseasementioning
In Part 1 of this two-part review, conceptual frameworks for defining skin diseases were articulated. In this review, the main approaches that can be used to develop diagnostic criteria for skin disease are summarized, using atopic dermatitis (AD) as an example. Different frameworks for defining skin disease for research purposes are articulated, including statistical, prognostic, operational, clinical and epidemiological approaches. All share the common aim of attempting to develop criteria that enable meaningful comparisons between groups of people. The desirable attributes of a good definition are described: diagnostic criteria should measure what they are meant to measure; the results should be the same for different assessors; the criteria should be coherent with what is known about that disease; they should reflect some degree of morbidity and not pick up subclinical disease; they should be easy to administer; and they should be applicable to a range of people of different ages, sexes/genders and ethnicities. Consensus-based criteria are contrasted with epidemiological derivation methods that assess the performance of diagnostic criteria in relation to a reference standard. The sensitivity and specificity of a disease definition is explained, along with how the trade-off between these two properties can vary, depending on the purpose of the study and the study setting. The review closes with some reflections on when it is appropriate to consider splitting a disease into more than one category and how diagnostic criteria can be interpreted in the clinical setting.
“…All diagnostic criteria should be developed using a clear and explicit methodology and replicated in independent studies. The methods used may progress over time from simple consensus 30 to epidemiological approaches 19 . The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful.•Diagnostic criteria are only guides in clinical practice whereas they are essential for research purposes so that similar groups can be compared.•Skin diseases can be defined by various approaches, ranging from simple consensus to case–control and cluster analysis methods.•Consensus criteria for a skin disease run the risk of determining the ‘eternal truth’ by a show of hands, and need to be revisited periodically in the light of new evidence.•Skin disease definitions must have demonstrable validity and applicability to a range of people of different ages, sex/genders and ethnicities.•The trade‐off between sensitivity and specificity of diagnostic criteria will vary according to their purpose.•Skin diseases should not be split prematurely on epiphenomena unless the new divisions are shown to be stable and useful for clinical and research purposes.…”
Section: Discussionmentioning
confidence: 99%
“…The methods used may progress over time from simple consensus 30 to epidemiological approaches. 19 The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful.…”
Section: Discussionmentioning
confidence: 99%
“…The methods used may progress over time from simple consensus 30 to epidemiological approaches. 19 The utility of such criteria in predicting important implications to patients such as prognosis or treatment response should also be articulated before they are declared as being useful. Learning points Diagnostic criteria are only guides in clinical practice whereas they are essential for research purposes so that similar groups can be compared.…”
Section: Discussionmentioning
confidence: 99%
“…Using a case–control approach, the frequency, validity and reliability of symptoms and signs of AD in typical cases and controls with other skin diseases were evaluated in a blinded fashion 16–18 (Table 2). Other researchers have used similar methodological approaches successfully 19 …”
Section: Diverse Approaches That Can Be Used For Defining Skin Diseasementioning
In Part 1 of this two-part review, conceptual frameworks for defining skin diseases were articulated. In this review, the main approaches that can be used to develop diagnostic criteria for skin disease are summarized, using atopic dermatitis (AD) as an example. Different frameworks for defining skin disease for research purposes are articulated, including statistical, prognostic, operational, clinical and epidemiological approaches. All share the common aim of attempting to develop criteria that enable meaningful comparisons between groups of people. The desirable attributes of a good definition are described: diagnostic criteria should measure what they are meant to measure; the results should be the same for different assessors; the criteria should be coherent with what is known about that disease; they should reflect some degree of morbidity and not pick up subclinical disease; they should be easy to administer; and they should be applicable to a range of people of different ages, sexes/genders and ethnicities. Consensus-based criteria are contrasted with epidemiological derivation methods that assess the performance of diagnostic criteria in relation to a reference standard. The sensitivity and specificity of a disease definition is explained, along with how the trade-off between these two properties can vary, depending on the purpose of the study and the study setting. The review closes with some reflections on when it is appropriate to consider splitting a disease into more than one category and how diagnostic criteria can be interpreted in the clinical setting.
“…Distinguishing between the commonest such disorder in much of the world, atopic eczema, and other less prevalent inflammatory dermatoses can be a challenge even for experienced dermatologists, let alone those without specific dermatology training. In this month’s issue of the British Journal of Dermatology , an impressive team from the UK and the Netherlands reports its conclusions from the DIPSOC study, 1 a case–control investigation examining which clinical criteria are of greatest diagnostic value in identifying psoriasis in children and adolescents.…”
ACD is a cell-mediated immune response following skin exposure to a chemical to which the individual has previously been sensitized. Risks of sensitization to chemicals include high concentration of the allergen, occlusion and long exposure time. Insulin pumps are attached to the skin for several days and glucose-monitoring MDs typically for 10 days, thus increasing the risk of sensitization. The diagnosis of ACD is confirmed by a positive patch test and current exposure to the relevant chemical. However, it was only an impressive multidisciplinary collaboration and the use of advanced chemical techniques that led to identification of the potent allergens IBOA and DMAA in MDs. Indeed, information from the manufacturers is lacking and the (full) chemical composition of the sensors is never disclosed. This is in contrast to consumer products, such as cosmetics, for which ingredients must be listed on the package label.New allergens are continuously emerging, in accordance with changes in the chemical contents of these MDs over time. Certain sensitizers remain unidentified in MDs, which creates a significant problem for patients reacting to them. Ulriksdotter et al. 7 raise the question of whether low molecular weight acrylates should even be present in MDs constantly worn on the skin. Lifelong use of MDs carries the risk of multisensitization and to avoid this, manufacturers should be urged to find other and less sensitizing solutions. Additionally, manufacturers of such devices should, to the best of their knowledge, disclose the chemical composition of all MD parts.
Die Psoriasis wird heute als multifaktorielle, entzündliche, immunmediierte Systemerkrankung mit vorrangiger Manifestation am Hautorgan aufgefasst. In etwa einem Drittel der Fälle beginnt sie bereits im Kindes- und Jugendalter und geht oft mit einer deutlichen Beeinträchtigung der Lebensqualität Betroffener und ihrer Eltern einher. Neben der genetischen Disposition sind Triggerfaktoren wie Streptokokkeninfektionen maßgeblich an der Manifestation und an Exazerbationen beteiligt. Auch die bereits in dieser Altersgruppe nachteilige Rolle von Komorbiditäten, allen voran die Adipositas, wurde inzwischen gut belegt. Die Behandlungsmöglichkeiten haben sich durch die Zulassung von nunmehr 5 Biologika im Kindesalter erheblich verbessert, werden aber noch unzureichend genutzt. Der vorliegende Beitrag gibt einen kurzen Überblick über den heutigen Wissensstand und die Empfehlungen der aktualisierten deutschen Leitlinie. Neben den häufigen Typen werden auch ungewöhnlichere Erscheinungsformen wie die pustulöse, die ekzematisierte und die durch TNF(Tumornekrosefaktor)-α-Inhibitoren induzierte „paradoxe“ Psoriasis thematisiert.
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