Desenvolvimento e validação de um escore dermatoscópico de gravidade da alopecia de padrão feminino
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Data
2018-08-23
Autores
Penha, Mariana Alvares [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Fundamentos: Alopecia de padrão feminino (APF) é doença crônica frequente, que inflige prejuízo à qualidade de vida e cujos tratamentos levam a melhoras tênues, com difícil percepção clínica a curto prazo. Apesar da prevalência e impacto na qualidade de vida, não há métodos de avaliação objetivos e sensíveis para estimar sua gravidade. Objetivos: Desenvolver um escore dermatoscópico de gravidade da APF. Métodos: Estudo transversal, envolvendo 76 mulheres com APF e 12 controles. Além de dados clínico-demográficos, capturaram-se fotos dermatoscópicas padronizadas de 1 cm2 do couro cabeludo (frontal e occipital) para avaliar os principais achados da APF. As variáveis foram selecionadas por técnicas multivariadas e seus pesos definidos por modelo linear generalizado. Vinte participantes foram retestadas. A validação externa e sensibilidade à mudança (responsividade) foram avaliados a partir das estimativas dos escores de dez pacientes com APF sob uso oral de minoxidil 1mg, por seis meses. Resultado: Entre as portadoras de APF, 8 (11%) apresentavam classificação de Sinclair grau 1, 40 (53%) 2, 19 (25%) 3, 9 (12%) 4 e 5. Foram aferidos 22 achados dermatoscópicos que compuseram 32 variáveis. À exploração multivariada, as variáveis que resultaram contribuição significativa para o escore foram: número de fios terminais, número de fios miniaturizados, sinal peripilar, rede pigmentada, halo branco, ponto amarelo; todos achados oriundos da avaliação frontal. O modelo final apresentou correlação (rho) de 0,89 com a ordenação clínica da gravidade da doença. O reteste resultou coeficiente de correlação intraclasse (ICC) 0,98 (p<0,01). Conclusão: Um escore objetivo e reprodutível de gravidade de APF foi criado e validado, permitindo seu uso como desfecho em ensaios terapêuticos.
Background: Female pattern alopecia (FPA) is a frequent chronic disease, which causes impaired quality of life and whose treatments lead to discreet improvements, with difficult clinical perception in the short term. Despite the prevalence and impact on quality of life, there are not objective and sensitive assessment methods to estimate its severity. Objective: To develop a dermoscopic severity score of FPA. Methods: A cross-sectional study, involving 76 women with FPA and 12 controls. In addition to clinical-demographic data, standardized 1 cm² dermoscopic photos of the scalp (frontal and occipital) were taken to evaluate the main findings of FPA. The variables were selected by multivariate analysis and their scores defined by generalized linear model. Twenty participants were retested. External validation and evaluation of responsiveness scores were based on the measurement of 10 patients showed improvement using oral minoxidil (1mg/d) for 6 months. Results: Among the participants with FPA, 8 patients (11%) presented the Sinclair classification grade 1, 40 (53%) 2, 19 (25%) 3, 9 (12%) 4 and 5. Twenty-two dermoscopic findings constituted 32 variables. At the multivariate exploration, the variables that were considered significant for the score were: total terminal hairs, total miniaturized hairs, brown peripilar signs, scalp honeycomb pigmentation, white peripilar sign, yellow dots; all findings from the frontal evaluation. The final model presented (rho) of 0.89 with the clinical order. The retests resulted in an intraclass correlation coefficient (ICC) of 0.98 (p <0.01). Conclusion: An objective and reproducible severity score of FPA was created and validated, allowing its use as an outcome in therapeutic trials.
Background: Female pattern alopecia (FPA) is a frequent chronic disease, which causes impaired quality of life and whose treatments lead to discreet improvements, with difficult clinical perception in the short term. Despite the prevalence and impact on quality of life, there are not objective and sensitive assessment methods to estimate its severity. Objective: To develop a dermoscopic severity score of FPA. Methods: A cross-sectional study, involving 76 women with FPA and 12 controls. In addition to clinical-demographic data, standardized 1 cm² dermoscopic photos of the scalp (frontal and occipital) were taken to evaluate the main findings of FPA. The variables were selected by multivariate analysis and their scores defined by generalized linear model. Twenty participants were retested. External validation and evaluation of responsiveness scores were based on the measurement of 10 patients showed improvement using oral minoxidil (1mg/d) for 6 months. Results: Among the participants with FPA, 8 patients (11%) presented the Sinclair classification grade 1, 40 (53%) 2, 19 (25%) 3, 9 (12%) 4 and 5. Twenty-two dermoscopic findings constituted 32 variables. At the multivariate exploration, the variables that were considered significant for the score were: total terminal hairs, total miniaturized hairs, brown peripilar signs, scalp honeycomb pigmentation, white peripilar sign, yellow dots; all findings from the frontal evaluation. The final model presented (rho) of 0.89 with the clinical order. The retests resulted in an intraclass correlation coefficient (ICC) of 0.98 (p <0.01). Conclusion: An objective and reproducible severity score of FPA was created and validated, allowing its use as an outcome in therapeutic trials.
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Palavras-chave
Dermatoscopia, Dermatologia, Alopecia, Gravidade do paciente, Índice de gravidade de doença, Dermoscopy, Patient Acuity, Severity of illness index, Dermatology