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Contributory Factors Identified for Discordant Severity Grading for Eczema, Psoriasis

Higher patient-graded severity for eczema, psoriasis linked to higher symptom expression, greater quality-of-life impairment

By Dermsquared Editorial Team | July 12, 2023

WEDNESDAY, July 12, 2023 -- Various factors have been identified that contribute to discordant severity grading (DSG) for eczema and psoriasis, according to a study published online July 12 in JAMA Dermatology.

Valencia Long, M.B.B.S., from the National University Healthcare System in Singapore, and colleagues tested and validated a model explaining the cognitive, behavioral, and disease factors associated with DSG. A theoretical model was derived in a qualitative study and was validated using structural equation modeling in this subsequent cross-sectional quantitative study. A total of 1,053 patients (76.2 percent with eczema and 23.8 percent with psoriasis) and their 44 attending physicians were recruited. The outcome was the difference between global disease severity as scored independently by the patient and dermatologist.

The researchers found that 46.3 percent of the 1,053 patient-physician pairs demonstrated discordance (42.4 percent positive [higher patient-graded severity] and 3.8 percent negative [lower patient-graded severity]). There was poor agreement observed between patient and physician rating (intraclass correlation, 0.27). Positive discordance was associated with higher symptom expression and greater quality-of-life impairment, but was not associated with patient or physician demographics. Higher quality-of-life impairment was associated with lower resilience and stability, increased negative social comparisons, lower self-efficacy, increased disease cyclicity, and greater expectation of chronicity.

"This study brings to the surface key lessons for dermatologists -- that many reasons for discordance are, in fact, modifiable," the authors write.

One author disclosed ties to the pharmaceutical industry.


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