The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability

BACKGROUND: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). OBJECTIVES: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE. METHODS: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. RESULTS: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90. CONCLUSIONS: Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.