Omission of Editor’s Note. An Editor’s Note should have been included in the Evidence-Based Dermatology Study by Charman et al titled “The Patient-Oriented Eczema Measure: Development and Initial Validation of a New Tool for Measuring Atopic Eczema Severity From the Patients’ Perspective,” published in the December issue of the ARCHIVES (2004;140:1513-1519). That Editor’s Note is printed here. The journal regrets the error.
Leaving its indelible imprints those fine tattoos of living known as poems
Charman and colleagues provide dermatologists with a new, much-needed tool to measure how much atopic dermatitis physically affects patients. The data presented show that this instrument has good psychometric properties (ie, it measures what it is supposed to measure), that it demonstrates these properties with good reliability (ie, when repeatedly measuring a given severity level in a patient, the scores obtained are quite similar), and that it has good sensitivity to change (ie, if the severity level of a given patient changes over time, the change is reflected by a similar change in the instrument).
The POEM (patient-oriented eczema measure) provides a disease-specific tool that may complement the dermatology-specific instrument already available. The Symptoms scale of the Skindex-29 questionnaire2 inquires about 7 symptoms (pain, burning/stinging, itch, irritation, hypersensitivity, bleeding, and being bothered by water). Sleep disturbance is also included in Skindex-29, but in the Social Functioning scale.
It is quite amazing that a tool that measures how much atopic dermatitis physically affects patients was missing for such an important skin condition. This disregard for patient-centered measurement may reflect the physician’s self-centered way of looking at a patient that italicasizes physical signs and disregards feelings. This inattention to patient feelings is also demonstrable in psoriasis3 : the main dermatology textbooks describe pruritus in psoriasis only in passing and rarely mention other symptoms.3 Such an attitude has negative consequences, not only for the patient’s well-being but also for the patient-physician relationship, and ultimately for the physician’s role. It may affect patient satisfaction, adherence to treatment, and the patient’s return to the same clinical center or office for follow-up visits.
Instruments such as the POEM and the Skindex-29 Symptoms scale will certainly be useful in controlled clinical trials, providing a much more comprehensive depiction of the effects of treatment. However, I really wish that these simple, single-page instruments would be used in everyday clinical practice—in reference centers and in private offices—to evaluate a patient’s status and to monitor it over time. Patients could fill out the questionnaires in the waiting room. Then, to score such questionnaires (ie, to obtain a valid, repeatable quantification of a patient’s severity) one need only add up 7 figures that range from 0 to 4 each. This could be done when the patient enters the office or while the patient undresses. Scoring could be managed by nurses or secretaries, but it sounds so easy, even a doctor could do it!
Damiano Abeni, MD, MPH
The Patient-Oriented Eczema Measure: Development and Initial Validation of a New Tool for Measuring Atopic Eczema Severity From the Patients’ Perspective—Correction. Arch Dermatol. 2005;141(3):381. doi:10.1001/archpedi.161.4.356