Digital photography as an operational tool for assessing corticosteroid-induced lipodystrophy

Background: Corticosteroid-induced lipodystrophy (CIL) is exclusively diagnosed in a subjective manner. Objective: To evaluate the reliability of digital photographs in the diagnosis of CIL. Methods: All consecutive patients starting long-term, high dosage corticosteroid therapy were photographed at baseline and after 3 months of therapy. At the end of the study, 3 physicians with expertise in corticosteroids classified patients as lipodystrophic yes/no/unclassifiable. Photographs analyses performed by 9 medical readers and evaluation of CIL using visual analog scale (VAS) performed during the M3 visit were compared to this classification. Results: Eighty-eight patients were monitored. Fifty of them were classified by the 3 experts as lipodystrophic and 30 as not lipodystrophic (8 were unclassifiable). Their intra- and inter-observer agreements were moderate or fair (K coefficient <= 0.57) when month 3 photographs were analysed alone and substantial or near perfect (K coefficient >= 0.75) when M3 photographs were analysed beside baseline ones. By comparison with expert consensus, only 3 out of 4 patients were correctly classified using VAS. The AUROC curve and inter-observer agreement significantly improved with experience for the 9 non-experts. Conclusion: The use of digital photographs do better than VAS to evaluate CIL. The accuracy of diagnosis improves with experience. Morphological changes are more important than morphological phenotype. (c) 2007 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.