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The development of a protocol for diagnosing hand dermatitis from photographic images

Parsons, Vaughan; Williams, Hywel; English, John; Llewellyn, Joanne; Ntani, Georgia; Madan, Ira

The development of a protocol for diagnosing hand dermatitis from photographic images Thumbnail


Vaughan Parsons

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Professor of Dermato-Epidemiology

John English

Joanne Llewellyn

Georgia Ntani

Ira Madan


Background: A hand photography protocol was needed to ascertain the presence and severity of dermatitis in a trial testing the effectiveness of a behaviour change intervention to prevent hand dermatitis in nurses.
Methods: We developed the protocol in three stages: (i) established a procedure for collecting hand photographs; (ii) conducted a stepwise validation process to agree rules for diagnosing and determining severity of hand dermatitis and; (iii) trained a research nurse to screen out ‘clear’ cases.
Results: We developed and trained fieldworkers (n=97) in a procedure for collecting hand photographs. Study dermatologists established interpretation rules to diagnose and determine the severity of dermatitis from photographs. Prior to the establishment of the rules, inter-observer agreement between the two dermatologists on the presence or absence of hand dermatitis was moderate (kappa 0.5). At the final stage of the validation process, the dermatologists agreed on 88% cases from independent assessments, with consensus reached for the remaining 12% following joint deliberation. Following training, a subgroup analysis of 250 cases screened by the nurse and characterised as ‘clear’ found two (0.8%) ‘positive’ cases were missed.
Conclusion: We have developed a hand photography protocol, which may be used in other studies or in hand dermatitis health surveillance programmes.


Parsons, V., Williams, H., English, J., Llewellyn, J., Ntani, G., & Madan, I. (2018). The development of a protocol for diagnosing hand dermatitis from photographic images. Contact Dermatitis, 79(5), 270-275.

Journal Article Type Article
Acceptance Date May 20, 2018
Online Publication Date Jul 3, 2018
Publication Date Nov 1, 2018
Deposit Date Jul 10, 2018
Publicly Available Date Jul 4, 2019
Journal Contact Dermatitis
Print ISSN 0105-1873
Electronic ISSN 1600-0536
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 79
Issue 5
Pages 270-275
Public URL
Publisher URL
Additional Information This is the peer reviewed version of the following article, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Contract Date Jul 10, 2018


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