Patient Performed Reading of a Phototest - A Reliable Method?
Keywords:Phototesting, Ultraviolet radiation, Self-assessment, Test reliability, Skin cancer, Prevention, Risk classification, Skin type, UV-sensitivity, Skin Malignancies
In various situations, in clinical practice or for prevention purposes directed at skin cancer, a broadened use of phototesting to estimate individual skin UV-sensitivity may be warranted. The aim of the present study was to investigate, in a primary health care population, the reliability of patient performed reading of a UVB phototest, when compared to the reading of a trained physician. Thirty-two subjects, all patients recruited in a primary health care population, underwent a UVB phototest, applied on the forearm. Test reading was performed after 24 hours, by the subjects themselves, by counting the number of erythemal reactions (0-6) detectable, and immediately after this, an independent control reading performed by a doctor was also done. The results showed a 72% absolute agreement between the subjects' readings and the control readings, and with a weighted kappa-value of 0.78 (95 CI: 0.64 - 0.91), i.e. corresponding to "substantial agreement". In conclusion, patient performed self-reading of a UVB phototest appears to be a fairly reliable method for estimation of individual skin UV-sensitivity, when compared to the reading of a trained observer. The finding opens up for a broadened use of phototesting in clinical practice and for preventive initiatives aiming at identifying at-risk individuals and reducing sun exposure.
Diffey BL, Farr PM. Quantitative aspects of ultraviolet erythema. Clin Phys Physiol Meas 1991; 12: 311-25. http://dx.doi.org/10.1088/0143-0815/12/4/001
Lock-Andersen J, Wulf HC. Threshold level for measurement of UV sensitivity: reproducibility of phototest. Photodermatol Photoimmunol Photomed 1996; 12: 154-61. http://dx.doi.org/10.1111/j.1600-0781.1996.tb00192.x
Falk M, Anderson C. Prevention of skin cancer in primary healthcare: an evaluation of three different prevention effort levels and the applicability of a phototest. Eur J Gen Pract 2008; 14: 68-75. http://dx.doi.org/10.1080/13814780802423430
Falk M, Magnusson H. Sun protection advice mediated by the general practitioner: An effective way to achieve long-term change of behaviour and attitudes related to sun exposure? Scand J Prim Health Care 2011; 29: 135-43. http://dx.doi.org/10.3109/02813432.2011.580088
Boni, R, Schuster C, Nehrhoff B, Burg G. Epidemiology of skin cancer. Neuro Endocrinol Lett 2002; 23(Suppl 2): 48-51.
Diepgen TL, Mahler V. The epidemiology of skin cancer. Br J Dermatol 2002; 146(Suppl 61): 1-6. http://dx.doi.org/10.1046/j.1365-2133.146.s61.2.x
Geller AC, Annas GD. Epidemiology of melanoma and nonmelanoma skin cancer. Semin Oncol Nurs 2003; 19: 2-11. http://dx.doi.org/10.1053/sonu.2003.50000
Leiter U, Garbe C. Epidemiology of melanoma and nonmelanoma skin cancer--the role of sunlight. Adv Exp Med Biol 2008; 624: 89-103. http://dx.doi.org/10.1007/978-0-387-77574-6_8
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-71. http://dx.doi.org/10.1001/archderm.1988.01670060015008
Boldeman C, Dal H, Kristjansson S, Lindelöf B. Is self-assessment of skin type a valid method for adolescents? J Am Acad Dermatol 2004; 50: 447-9. http://dx.doi.org/10.1016/j.jaad.2003.08.009
Rampen FH, Fleuren BA, deBoo TM, Lemmens WA. Unreliability of self-reported burning tendency and tanning ability. Arch Dermatol 1988; 124: 885-8. http://dx.doi.org/10.1001/archderm.1988.01670060031011
Falk M. Differences in sun exposure habits between self-reported skin type and ultraviolet sensitivity measured by phototest. Photodermatol Photoimmunol Photomed 2011; 27: 190-5. http://dx.doi.org/10.1111/j.1600-0781.2011.00599.x
Falk M, Anderson C. Reliability of self-assessed reading of skin tests: a possible approach in research and clinical practice? Dermatol Online J 2010; 16: 4.
Howard TP, Solomon DA. Reading the tuberculin skin test. Who, when, and how? Arch Intern Med 1988; 148: 2457-9. http://dx.doi.org/10.1001/archinte.1988.00380110093020
Gourevitch MN, et al. Self-assessment of tuberculin skin test reactions by drug users with or at risk for human immunodeficiency virus infection. Int J Tuberc Lung Dis 1999; 3: 321-5.
Ozuah PO, Burton W, Lerro KA, Rosenstock J, Mulvihill M. Assessing the validity of tuberculin skin test readings by trained professionals and patients. Chest 1999; 116: 104-6. http://dx.doi.org/10.1378/chest.116.1.104
Selby CD, Allen MB, Leitch AG. How well do the general public read Heaf skin tests? Respir Med 1990; 84: 245-8. http://dx.doi.org/10.1016/S0954-6111(08)80043-1
Prezant DJ, et al. Self-assessment of tuberculin skin test reactions by New York City firefighters: reliability and cost-effectiveness in an occupational health care setting. Ann Intern Med 1996; 125: 280-3.
Navin JA, Kaplan JE, Desilvio EL. Self-reading of PPD skin tests. J Am Coll Health 1994. 43: 37-8. http://dx.doi.org/10.1080/07448481.1994.9939083
Huerta, M, Balicer RD, Mimouni D, et al. Validity of self-assessment of skin reaction after smallpox vaccination. Public Health Rep 2006; 121: 45-50.
Josefson A., Svensson, A, Färm G, Engfeldt M, Meding B. Validation of Self-testing as a Method to Estimate the Prevalence of Nickel Allergy. Acta Derm Venereol 2011; 91: 526-30.
Carlsson A, Gånemo A, Anderson CD, Meding B, Stenberg B, Svensson A. Scoring of hand eczema: good agreement between patients and dermatological staff. Br J Dermatol 2011; 165: 123-8. http://dx.doi.org/10.1111/j.1365-2133.2011.10312.x
Kulp JL, Chaudhry S, Wiita B, Bachmann G. The accuracy of women performing vaginal pH self-testing. J Womens Health (Larchmt) 2008; 17: 523-6. http://dx.doi.org/10.1089/jwh.2007.0446
Ferris DG, Francis SL, Dickman ED, Miler-Miles K, Waller JL, McClendon N. Variability of vaginal pH determination by patients and clinicians. J Am Board Fam Med 2006; 19: 368-73. http://dx.doi.org/10.3122/jabfm.19.4.368
Shaw J, Kerry S, Adjei-Gyamfi Y, et al. Are stroke patients' reports of home blood pressure readings reliable? Cross-sectional study. Fam Pract 2011; 28: 118-22. http://dx.doi.org/10.1093/fampra/cmq087
Hamilton W, Round A, Goodchild R, Baker C. Do community based self-reading sphygmomanometers improve detection of hypertension? A feasibility study. J Public Health Med 2003; 25: 125-30. http://dx.doi.org/10.1093/pubmed/fdg027
Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ 1992; 304: 1491-4. http://dx.doi.org/10.1136/bmj.304.6840.1491
Harrison SL, Buttner PG. Do all fair-skinned Caucasians consider themselves fair? Prev Med 1999; 29: 349-54. http://dx.doi.org/10.1006/pmed.1999.0555
Ilias MA, Falk M, Wårdell K, Anderson C. Phototesting based on a divergent beam--a study on normal subjects. Photodermatol Photoimmunol Photomed 2001; 17: 189-96. http://dx.doi.org/10.1034/j.1600-0781.2001.170409.x
Farr PM, Besag JE, Diffey BL. The time course of UVB and UVC erythema. J Invest Dermatol 1988; 91: 454-7. http://dx.doi.org/10.1111/1523-1747.ep12476577
Leslie KS, Lodge E, Garioch JJ. A comparison of narrowband (TL-01) UVB-induced erythemal response at different body sites. Clin Exp Dermatol 2005; 30: 337-9. http://dx.doi.org/10.1111/j.1365-2230.2005.01845.x
Roelandts R. The diagnosis of photosensitivity. Arch Dermatol 2000; 136: 1152-7. http://dx.doi.org/10.1001/archderm.136.9.1152
Kim JJ, Lim HW. Evaluation of the photosensitive patient. Semin Cutan Med Surg 1999; 18: 253-6. http://dx.doi.org/10.1016/S1085-5629(99)80024-8
Bylaite M, Grigaitiene J, Lapinskaite GS. Photodermatoses: classification, evaluation and management. Br J Dermatol 2009; 161 Suppl 3: 61-8. http://dx.doi.org/10.1111/j.1365-2133.2009.09451.x
Gordon PM, Saunders PJ, Diffey BL, Farr PM. Phototesting prior to narrowband (TL-01) ultraviolet B phototherapy. Br J Dermatol 1998; 139: 811-4. http://dx.doi.org/10.1046/j.1365-2133.1998.02505.x
Falk M, Ilias M, Anderson C. Inter-observer variability in reading of phototest reactions with sharply or diffusely delineated borders. Skin Res Technol 2008; 14: 397-402. http://dx.doi.org/10.1111/j.1600-0846.2008.00305.x
Svedberg P. Attitudes to health promotion interventions among patients in mental health services--differences in relation to socio-demographic, clinical and health-related variables. J Ment Health 2011; 20: 126-35. http://dx.doi.org/10.3109/09638237.2010.507684
Santmyire BR, Feldman SR, Fleischer Jr AB. Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the United States: results of the 1998 National Health Interview Survey. Cancer 2001; 92: 1315-24. http://dx.doi.org/10.1002/1097-0142(20010901)92:5<1315::AID-CNCR1453>3.0.CO;2-I
Branstrom R, Kasparian NA, Chang YM, et al. Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev 2010; 19: 2199-210. http://dx.doi.org/10.1158/1055-9965.EPI-10-0196
Kasparian NA, McLoone JK, Meiser B. Skin cancer-related prevention and screening behaviors: a review of the literature. J Behav Med 2009; 32: 406-28. http://dx.doi.org/10.1007/s10865-009-9219-2