New photographic grading scales focus on perioral aesthetic features
Dr. Cohen, director, AboutSkin Dermatology and Derm Surgery, Englewood, Colo., says he identified the need for developing a validated grading scale to quantify the severity of aesthetic features of the perioral area as he began planning a dose-response study of onabotulinumtoxinA (Botox, Allergan) for treatment of perioral lines with animation.
Working in collaboration with several other physicians and researchers at Allergan, several four-point, lip-specific photographic scales were developed based on review of two-dimensional images of healthy volunteers. One scale rates the severity of vertical perioral lines at rest (POL), a second is for vertical perioral lines at maximum contraction (POLM), and the third describes the oral commissures, including marionette lines (OCS). Each scale includes grades of none, mild, moderate, and severe, and features three exemplary photos for each grade level.
Validation testing of the scales was undertaken in a study during which eight physicians specializing in aesthetic dermatology or plastic surgery used the instruments to rate 55 pre-screened subjects in live reviews. The physicians repeated the task in a second round to assess intra-rater variability, and the subjects were also asked to rate themselves at each round using the severity scales.
Statistical analyses using Pearson correlation coefficient testing showed almost perfect inter-rater agreement for all three scales at both rounds, while intra-rater agreement for each scale was substantial or almost perfect, Dr. Cohen says.
For the subjects' self-assessment ratings, these study subjects themselves had intra-rater agreement ranging from moderate to substantial, and there was also substantial agreement for all three scales between the subject and physician raters at both rounds, says Dr. Cohen, who subsequently used the POL and POLM scales in a multicenter dose-ranging clinical trial of onabotulinumtoxinA injection into the oris orbicularis muscle that he performed with Steve Dayan, M.D., Chicago, and Sue Ellen Cox, M.D., Chapel Hill, N.C.
"It was an interesting experience to address a gap in our clinical assessment tools — the lack of a perioral rating scale — and it was satisfying to be successful in starting from the ground up and developing scales for the perioral area with good reliability that were subsequently used in the setting of a clinical trial," Dr. Cohen says.
"Validated rating scales have an important role in supporting claims of efficacy from clinical studies of aesthetic treatments and allow inter-study comparisons.
"However, I also find they are a useful aid in clinical practice, both as a patient education tool pre-procedure, especially for discussing realistic expectations of treatments, and for evaluating or reinforcing to patients their improvement after procedures," he says.
MORE ARTICLES IN THIS ISSUE
Combining home-care regimens with office laser procedures helps dermatologists achieve better results when targeting almost any skin problem, says Ranella Hirsch, M.D., clinical assistant professor of dermatology, Boston University School of Medicine. Not only do patients benefit from the laser treatment, the home-care regimen can offer an "extra oomph," Dr. Hirsch says.
Because melanoma in children occurs very rarely, dermatologists should prioritize only those types of melanocytic nevi that can pose problems: Spitzoid nevi and large congenital melanocytic nevi (CMN), according to Elvira Moscarella, M.D.
Modern diagnostic skin evaluation tools such as dermoscopy and mole mapping with total body photography (TBP) have proven very useful in the diagnosis of suspicious cutaneous lesions and early recognition of malignant melanoma (MM). The combination of these two technologies can result in even more accurate assessment of the lesions viewed, according to Joseph Malvehy, M.D., coordinator, Melanoma Unit, department of dermatology, Hospital Clinic IDIBAPS, Barcelona, Spain, at the 2011 International Melanoma Congress.
The combination of a topical corticosteroid with a physiologic lipid-containing product is an effective approach for the management of atopic dermatitis and other steroid-responsive dermatoses because it simultaneously addresses disease-related inflammation and the barrier impairment that can be worsened by a topical corticosteroid alone, according to Matthew J. Zirwas, M.D.
Dermatologists are best positioned to accurately diagnose cellulitis, a common misdiagnosis for look-alike conditions ranging from stasis dermatitis to cutaneous cancers, according to Daniela Kroshinsky, M.D.