Abstract:
BACKGROUND:Onychomycosis (fungal infection of the toenails or fingernails) is common, affecting up to 8% of the general population. Telephone and mailed surveys conducted to study this disease are usually completed via patient self-report. The validity of the counts of diseased nails reported by the patients participating in these surveys has not been established. OBJECTIVE:The aim of this study was to assess the interrater agreement between patient and health care professional (HCP) counts of affected nails in patients with onychomycosis. METHODS:Patient and HCP counts of infected toenails and fingernails corresponding to a total of 567 patients originating from 3 different clinical trials were retrospectively analyzed. All these patients were initially classified as mycologically positive for toenail onychomycosis, and all 3 trials used identical self-administered questions regarding counts of infected toenails and fingernails. The level of agreement between patient versus HCP counts of infected toenails and fingernails (based on collapsed and uncollapsed counts) was measured using the quadratically weighted kappa statistic. RESULTS:Thirty-eight percent (213/554, 95% confidence interval [CI] = 35% to 43%) of the 554 patients with self-reported and HCP counts of infected toenails had exact agreement; for these 554 patients, quadratically weighted kappa = 0.47 (95% CI: 0.40 to 0.54). The highest agreement rates-79, 62, and 50%-correspond to the patients with HCP counts of affected toenails equaling 1, 2, and 10, respectively; that is, HCP counts at the extremes. The agreement rates ranged from 3% to 31% for the remaining patients with HCP counts between 3 and 9. Patients tended to undercount affected toenails, irrespective of the number of affected toenails counted by HCPs. No statistically significant association was found between agreement rates and whether or not the patients had been previously treated for toenail onychomycosis (P = .91). A marginally nonsignificant association of increasing agreement rates with increasing disease duration was observed (P = .06). Among the patients who reported one or more affected fingernails (n = 122), percent agreement was similar to that of toenails (41%, 95% CI: 33.0 to 50.0%). LIMITATIONS:This pilot study is limited by its retrospective design, its homogeneous group of patients (predominantly white, male veterans), and the fact that information on intraobserver and interobserver reliability was not obtained from all of the 3 clinical trials, the sources for this analysis. CONCLUSIONS:Patients tend to undercount affected nails as compared to HCPs. Reliance on self-reported counts in epidemiological surveys may lead to an inaccurate, underestimate of disease severity.
journal_name
J Am Acad Dermatoljournal_title
Journal of the American Academy of Dermatologyauthors
Cham PM,Chen SC,Grill JP,Warshaw EMdoi
10.1016/j.jaad.2007.09.022subject
Has Abstractpub_date
2008-01-01 00:00:00pages
136-41issue
1eissn
0190-9622issn
1097-6787pii
S0190-9622(07)01450-8journal_volume
58pub_type
杂志文章abstract:BACKGROUND:The concept of contact allergy aggravating or inducing oral lichenoid mucositis diagnosed as oral lichen planus (OLP) is well recognized but somewhat controversial. OBJECTIVE:We sought to identify clinically relevant contact allergens that may be important in the management of patients with OLP. METHODS:We...
journal_title:Journal of the American Academy of Dermatology
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abstract::Various cutaneous signs and syndromes have been associated with hepatitis B virus infection. This is a report of the clinical, pathologic, immunofluorescence, and immunoperoxidase studies of peculiar papular lesions that have been observed to occur during the chronic phase of hepatitis B virus infection. A total of th...
journal_title:Journal of the American Academy of Dermatology
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doi:10.1016/s0190-9622(87)70002-4
更新日期:1987-01-01 00:00:00
abstract::The Fourth Annual Symposium on Hidradenitis Suppurativa (SHSA) took place on November 1-3, 2019, at the Westin Book Cadillac Hotel in Detroit, Michigan. This symposium was a joint meeting of the US Hidradenitis Suppurativa Foundation and the Canadian Hidradenitis Suppurativa Foundation. This cross-disciplinary meeting...
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abstract::One hundred three patients with acne vulgaris were randomly designated to receive either a topical formulation of erythromycin plus zinc or a topical solution of 1% clindamycin phosphate (Cleocin-T). The patients treated themselves twice daily and were examined at 3, 6, 9, and 12 weeks after the start of therapy. By w...
journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,随机对照试验
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abstract::Sixteen patients with granular cell tumors were seen between 1964 and 1979. The medical data of these patients showed an average age incidence of 39 years and a greater frequency among Negroes (69%) and in female patients (62.5%). The most common sign (in 12 of 16 patients) was the presence of an asymptomatic mass. Th...
journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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abstract::Cytodestructive or surgical therapy for patients with anogenital warts is frequently associated with recurrence. In February 1997, the US Food and Drug Administration approved imiquimod as a 5% cream for the treatment of anogenital warts. Activity of the drug results primarily from interferon alfa and other cytokine i...
journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,多中心研究
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更新日期:2019-09-01 00:00:00
abstract::A woman with pemphigus vulgaris was treated by plasma exchange. Four separate exchanges of approximately 4,000 ml each were performed over a 2-week period. The patient's pemphigus antibody titer decreased from 1/320 before the first exchange to 1/20 after the final exchange, and no new lesions developed for 3 weeks fo...
journal_title:Journal of the American Academy of Dermatology
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更新日期:1981-03-01 00:00:00
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journal_title:Journal of the American Academy of Dermatology
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更新日期:1989-07-01 00:00:00
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journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1986-08-01 00:00:00
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journal_title:Journal of the American Academy of Dermatology
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更新日期:1993-04-01 00:00:00
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journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
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journal_title:Journal of the American Academy of Dermatology
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journal_title:Journal of the American Academy of Dermatology
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abstract::We report a case of dermatomyositis presenting with cutaneous mucinosis as the sole manifestation. A malignancy screen revealed an underlying nasopharyngeal carcinoma. ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
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更新日期:2003-05-01 00:00:00
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journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/0190-9622(90)70125-2
更新日期:1990-05-01 00:00:00
abstract::Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly ...
journal_title:Journal of the American Academy of Dermatology
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更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Glial cell line-derived neurotrophic factor (GDNF) and a related family member, neurturin (NTN), and their cognate receptors (GFRalpha-1 and GFRalpha-2, for GDNF and NTN, respectively) are distal members of the transforming growth factor-beta superfamily. They are involved in the control of murine hair folli...
journal_title:Journal of the American Academy of Dermatology
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更新日期:2008-02-01 00:00:00
abstract::Reflections from instruments in the surgical field involving the CO2 laser beam present a serious ocular hazard. In addition to the use of plastic or glass protective eyewear, this hazard can be minimized by utilizing anodized instruments and recognizing the specific distances at which various reflections are no longe...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
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更新日期:1987-11-01 00:00:00