La durometría en la valoración de la psoriasis en placas, un estudio exploratorio

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Artículo de investigación
Rev Asoc Colomb Dermatol. 2019; 27 : 1 (enero - marzo), 16-27

La durometría en la valoración de la psoriasis en placas, un estudio exploratorio

The durometry in the assessment of psoriasis plate, an exploratory study
Autor(es): 
Jhonatan Quintero
Jhonaqo84@gmail.com
Médico cirujano, residente de tercer año de Dermatología, Universidad de Caldas, Manizales, Colombia
Felipe Jaramillo-Ayerbe
Médico cirujano, dermatólogo, dermatopatólogo; jefe, Programa de Dermatología, Universidad de Caldas, Manizales, Colombia
Ana María Hoyos
Médica cirujana, dermatóloga, Universidad de Caldas, docente, Programa de Dermatología, Universidad de Caldas, Manizales, Colombia
José Arnoby Chacón
Médico, MSP; profesor, Universidad de Caldas, Manizales, Colombia
Resumen: 

Introducción: La psoriasis exhibe cambios biomecánicos en la dureza de la piel; no existen marcadores para medir su actividad y su seguimiento se basa en la ‘clinimetría’. Una de las deficiencias del PASI (Psoriasis Area Severity Index) es la interdependencia entre sus variables y la controversia al definir la induración de la placa, según su altura o su semiología. El durómetro, un aparato que mide la dureza de materiales, fue probado por primera vez para medir esta característica.

Métodos: Dos evaluadores con un durómetro calibrado de fábrica, midieron en unidades de dureza placas de psoriasis y piel ‘sana’ como control. Los resultados se analizaron con la t de Student y el ANOVA para grupos pareados con medidas repetidas, el coeficiente de correlación de Pearson y la varianza de Fisher, y la correlación y la concordancia con regresión lineal e índice kappa.

Resultados y conclusiones: Se midieron 33 placas de 13 pacientes con un PASI promedio de 11. Los evaluadores obtuvieron un coeficiente de Pearson de 0,37 para la durometría y de 0,22 para el PASI. La varianza fue mayor de 20 entre las placas y la piel sana. Entre evaluadores, el coeficiente de Pearson fue de 0,95 y el índice kappa de 0,88 con un índice de confianza del 95 % y una p menor de 0,05.

La durometría no se correlacionó con el PASI. Sin embargo, es factible una recali­bración en su función, mediante más estudios con una muestra de mayor tamaño y analizando los efectos del esquema terapéutico en el tiempo. La durometría es útil en la valoración de la dureza de la placa de psoriasis, con adecuadas correla­ción y concordancia entre evaluadores.

Palabras clave: 
psoriasis, placa, induración, dureza

Summary: 

Background: Psoriasis biomechanically exhibits changes in the hardness of the skin; there are no markers to measure their activity and their follow-up is based on clinimetry. One of the deficiencies of the PASI is the interdepen­dence between its variables and the controversy when defining the "indura­tion" of the plate, either from its height or from semiology. The durometer, an apparatus that measures the hardness of materials, was tested for the first time to measure this charac­teristic.

Methods: Two evaluators (E1 and E2) with a fac­tory calibrated durometer, measured in hardness units both plaques and "healthy" skin control. The analysis was performed using Student's t-test and ANOVA for paired groups with repeated measures, Pearson's correlation coefficient (r), Fisher's va­riance (F) and correlation and agreement using li­near regression and Kappa index.

Results and conclusions: Thirty-three plaques were obtained from 13 patients with average PASI of 11. E1 and E2 obtained r=0.37 and 0.22 between the durometry vs. IndPASI. An F>20 between plates vs. healthy skin; Inter-rater an r=0.95, and a kappa index of 0.88 with 95%CI and p<0.05. Durometry does not correlate with PASI. However, a recalibra­tion in its function is feasible, requiring more stu­dies with a larger sample, analyzing the effects of the therapeutic scheme over time. The durometry is useful in the assessment of the hardness of the pso­riasis plaque, with adequate correlation and inter-rater agreement.

Key words: 
Psoriasis, plaque, induration, hardness
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