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Published in: Chinese Medicine 1/2013

Open Access 01-12-2013 | Research

Developing a diagnostic checklist of traditional Chinese medicine symptoms and signs for psoriasis: a Delphi study

Authors: Xuesong Yang, Virasakdi Chongsuvivatwong, Edward McNeil, Jianzhou Ye, Xiaoyong Ouyang, Enpin Yang, Hutcha Sriplung

Published in: Chinese Medicine | Issue 1/2013

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Abstract

Background

Psoriasis is a chronic inflammatory skin disease with a genetic basis. Its ill-defined causes make it difficult to diagnose. This study aims to develop a diagnostic checklist for psoriasis classification in the context of traditional Chinese medicine.

Methods

A Delphi study was conducted with three rounds by a panel of 16 dermatology experts to develop a checklist for traditional Chinese medicine symptoms and signs of psoriasis. Dermatology experts in psoriasis research, nine in Yunnan and seven in Beijing, were selected as the expert panel. The initial list of symptoms and signs in psoriasis was developed by reviewing the literature retrieved from Chinese and English journals. Experts rated each item of the list on a 5-point Likert scale. The list was revised and re-evaluated in the same manner for a total of 3 rounds before it was finalized.

Results

One hundred and thirty items were extracted from the literature review. After three rounds of expert ratings, 96 items were retained with eight domains: color, type and shape of skin lesion, physical expression, tongue and coating, pulse, associated factors, and living environment. Intraclass correlation coefficient and Kappa statistics indicated an inter-rater agreement in the final checklist.

Conclusion

A checklist containing 96 items in 8 domains was developed for psoriasis diagnosis using traditional Chinese medicine symptoms and signs.
Appendix
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Literature
1.
go back to reference Rook A, Savin JA, Wilkinson DS: The Prevalence, Incidence and Ecology of Diseases of The Skin. Textbook of Dermatology. Edited by: Rook A, Wtlkinson DS, Ebling FJG. 1986, Palo Alto: Blackwell Scientific Publications, 39-53. 4 Rook A, Savin JA, Wilkinson DS: The Prevalence, Incidence and Ecology of Diseases of The Skin. Textbook of Dermatology. Edited by: Rook A, Wtlkinson DS, Ebling FJG. 1986, Palo Alto: Blackwell Scientific Publications, 39-53. 4
2.
go back to reference Stern RS, Nijsten T, Feldman SR: Psoriasis is common, carries a substantial burdeneven when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004, 9: 136-139. 10.1046/j.1087-0024.2003.09102.x.CrossRefPubMed Stern RS, Nijsten T, Feldman SR: Psoriasis is common, carries a substantial burdeneven when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004, 9: 136-139. 10.1046/j.1087-0024.2003.09102.x.CrossRefPubMed
3.
go back to reference Naldi L: Epidemiology of psoriasis. Curr Drug Targets Imflamm Allergy. 2004, 3: 121-128. 10.2174/1568010043343958.CrossRef Naldi L: Epidemiology of psoriasis. Curr Drug Targets Imflamm Allergy. 2004, 3: 121-128. 10.2174/1568010043343958.CrossRef
4.
go back to reference Raychaudhuri SP, Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2001, 15: 16-17.CrossRefPubMed Raychaudhuri SP, Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2001, 15: 16-17.CrossRefPubMed
5.
go back to reference Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE: The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982–1991. J Rheumatol. 2000, 27: 1247-1250.PubMed Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE: The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982–1991. J Rheumatol. 2000, 27: 1247-1250.PubMed
6.
go back to reference Gladman DD: Psoriatic arthritis. Dermatol Ther. 2004, 17: 350-363. 10.1111/j.1396-0296.2004.04038.x.CrossRefPubMed Gladman DD: Psoriatic arthritis. Dermatol Ther. 2004, 17: 350-363. 10.1111/j.1396-0296.2004.04038.x.CrossRefPubMed
7.
go back to reference Taylor WJ: Epidemiology of psoriatic arthritis. Curr Opin Rheumatol. 2002, 14: 98-103. 10.1097/00002281-200203000-00004.CrossRefPubMed Taylor WJ: Epidemiology of psoriatic arthritis. Curr Opin Rheumatol. 2002, 14: 98-103. 10.1097/00002281-200203000-00004.CrossRefPubMed
8.
go back to reference Raychaudhuri S, Farber E: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2008, 15 (1): 16-17.CrossRef Raychaudhuri S, Farber E: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2008, 15 (1): 16-17.CrossRef
9.
go back to reference Chandran V, Raychaudhuri SP: Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010, 34 (3): 314-321. 10.1016/j.jaut.2009.12.001.CrossRef Chandran V, Raychaudhuri SP: Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010, 34 (3): 314-321. 10.1016/j.jaut.2009.12.001.CrossRef
10.
go back to reference Gudjonsson JE, Elder JT: Psoriasis: epidemiology. Clin Dermatol. 2007, 25 (6): 535-546. 10.1016/j.clindermatol.2007.08.007.CrossRefPubMed Gudjonsson JE, Elder JT: Psoriasis: epidemiology. Clin Dermatol. 2007, 25 (6): 535-546. 10.1016/j.clindermatol.2007.08.007.CrossRefPubMed
11.
go back to reference Gudjonsson Koo J: Systemic sequential therapy of psoriasis: a new paradigm for Improved therapeutic results. J Am Acad Dermatol. 1999, 41 (3): S25-S28. 10.1016/S0190-9622(99)70363-4.CrossRef Gudjonsson Koo J: Systemic sequential therapy of psoriasis: a new paradigm for Improved therapeutic results. J Am Acad Dermatol. 1999, 41 (3): S25-S28. 10.1016/S0190-9622(99)70363-4.CrossRef
12.
go back to reference Koo J: Current consensus and update on psoriasis therapy: a perspective from the US. J Dermatol. 1999, 26 (11): 723-733.CrossRefPubMed Koo J: Current consensus and update on psoriasis therapy: a perspective from the US. J Dermatol. 1999, 26 (11): 723-733.CrossRefPubMed
13.
go back to reference Fleischer AB, Feldman SR, Rapp SR, Reboussin DM, Exum ML, Clark AR: Alternative therapies commonly used within a population of patients with psoriasis. Cutis. 1996, 58: 216-220.PubMed Fleischer AB, Feldman SR, Rapp SR, Reboussin DM, Exum ML, Clark AR: Alternative therapies commonly used within a population of patients with psoriasis. Cutis. 1996, 58: 216-220.PubMed
14.
go back to reference Koo J, Desai R: Traditional Chinese medicine in dermatology. Dermatol Ther. 2003, 16: 98-105. 10.1046/j.1529-8019.2003.01617.x.CrossRefPubMed Koo J, Desai R: Traditional Chinese medicine in dermatology. Dermatol Ther. 2003, 16: 98-105. 10.1046/j.1529-8019.2003.01617.x.CrossRefPubMed
15.
go back to reference Jiang M, Zhang C, Zheng G, Guo H, Li L, Yang J, Lu C, Jia W, Lu A: Traditional Chinese Medicine Zheng in the Era of Evidence-Based Medicine: A Literature Analysis. Evid Based Complement Alternat Med. 2012, 2012: 409568-PubMedCentralPubMed Jiang M, Zhang C, Zheng G, Guo H, Li L, Yang J, Lu C, Jia W, Lu A: Traditional Chinese Medicine Zheng in the Era of Evidence-Based Medicine: A Literature Analysis. Evid Based Complement Alternat Med. 2012, 2012: 409568-PubMedCentralPubMed
16.
go back to reference Cao YF: Zhu Bing Yuan Hou Lun. 1982, Beijing: People's Medical Publishing House, [In Chinese] Cao YF: Zhu Bing Yuan Hou Lun. 1982, Beijing: People's Medical Publishing House, [In Chinese]
17.
go back to reference Surgery of Traditional Chinese Medicine. Edited by: Lu DM. 1997, Shanghai: Shanghai Science &Technique Press, 2 Surgery of Traditional Chinese Medicine. Edited by: Lu DM. 1997, Shanghai: Shanghai Science &Technique Press, 2
18.
go back to reference Lu AP, Jia HW, Xiao C: Theory of traditional Chinese medicine and therapeutic method of diseases [In Chinese]. World J Gastroenterol. 2004, 10: 1854-1856.PubMedCentralCrossRefPubMed Lu AP, Jia HW, Xiao C: Theory of traditional Chinese medicine and therapeutic method of diseases [In Chinese]. World J Gastroenterol. 2004, 10: 1854-1856.PubMedCentralCrossRefPubMed
19.
go back to reference Xu JX, Jiao AQ: The Conception and Syndromes of Traditional Chinese Medicine Standardization Research Chinese. Zhong Guo Zhong Yi Ji Chu Yi Xue (Chin J Basic Med TCM). 2005, 11: 261-265. Xu JX, Jiao AQ: The Conception and Syndromes of Traditional Chinese Medicine Standardization Research Chinese. Zhong Guo Zhong Yi Ji Chu Yi Xue (Chin J Basic Med TCM). 2005, 11: 261-265.
20.
go back to reference Jiang YQ: The Influence of Geographic Difference of Syndromes Differentiation between Southern and Northern in China. Zhong Yi Za Zhi (J Trad Chin Med). 1991, 2: 49-51. Jiang YQ: The Influence of Geographic Difference of Syndromes Differentiation between Southern and Northern in China. Zhong Yi Za Zhi (J Trad Chin Med). 1991, 2: 49-51.
21.
go back to reference Linstone H, Turoff M: The Delphi method: techniques and applications. 2002, Newark: New Jersey Institute of Technology Linstone H, Turoff M: The Delphi method: techniques and applications. 2002, Newark: New Jersey Institute of Technology
24.
go back to reference Linstone HA, Turoff M: The Delphi method: Techniques and applications. 1975, London: Addison- Wesley Publishing Company, Advanced Book Program Linstone HA, Turoff M: The Delphi method: Techniques and applications. 1975, London: Addison- Wesley Publishing Company, Advanced Book Program
25.
go back to reference Roth RM, Wood WC: A Delphi approach to acquiring knowledge from single and multiple experts. 1990, Orlando: Association for Computing MachineryCrossRef Roth RM, Wood WC: A Delphi approach to acquiring knowledge from single and multiple experts. 1990, Orlando: Association for Computing MachineryCrossRef
26.
go back to reference Fleiss JL, Cohen J: The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973, 33: 613-619. 10.1177/001316447303300309.CrossRef Fleiss JL, Cohen J: The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973, 33: 613-619. 10.1177/001316447303300309.CrossRef
27.
30.
go back to reference Robinson A, Kardos M, Kimball AB: Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): Why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. J Am Acad Dermatol. 2011, 66: 369-375.CrossRefPubMed Robinson A, Kardos M, Kimball AB: Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): Why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. J Am Acad Dermatol. 2011, 66: 369-375.CrossRefPubMed
31.
go back to reference Setty AR, Curhan G, Choi HK: Smoking and the risk of psoriasis in women: Nurses' Health Study II. Am J Med. 2007, 120: 953-959. 10.1016/j.amjmed.2007.06.020.PubMedCentralCrossRefPubMed Setty AR, Curhan G, Choi HK: Smoking and the risk of psoriasis in women: Nurses' Health Study II. Am J Med. 2007, 120: 953-959. 10.1016/j.amjmed.2007.06.020.PubMedCentralCrossRefPubMed
32.
go back to reference Gao XJ: Explore Relationship of Spleen and Stomach theory between Gastric-Intestinal and Pancreatic Endocrine System. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chin J IntegTrad West Med). 1984, 4: 186-188. Gao XJ: Explore Relationship of Spleen and Stomach theory between Gastric-Intestinal and Pancreatic Endocrine System. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chin J IntegTrad West Med). 1984, 4: 186-188.
33.
go back to reference Shang X, Zeng C, Zhang YZ: Dispersing and Discharging Function of The Liver Associated with Gynecological Emotion Diseases. Hunan Zhong Yi Za Zhi (Hunan J Trad Chin Med). 2005, 21: 90-91. Shang X, Zeng C, Zhang YZ: Dispersing and Discharging Function of The Liver Associated with Gynecological Emotion Diseases. Hunan Zhong Yi Za Zhi (Hunan J Trad Chin Med). 2005, 21: 90-91.
34.
go back to reference Prignano F, Ricceri F, Pescitelli L, Lotti T: Itch in psoriasis: epidemiology, clinical aspects and treatment options. Clin Cosmet Investig Dermatol. 2009, 2: 9-13.PubMedCentralCrossRefPubMed Prignano F, Ricceri F, Pescitelli L, Lotti T: Itch in psoriasis: epidemiology, clinical aspects and treatment options. Clin Cosmet Investig Dermatol. 2009, 2: 9-13.PubMedCentralCrossRefPubMed
35.
go back to reference Van de Kerkhof P, De Hoop D, De Korte J, Cobelens S, Kuipers M: Patient compliance and disease management in the treatment of psoriasis in the Netherlands. Dermatol. 2000, 200: 292-298. 10.1159/000018390.CrossRef Van de Kerkhof P, De Hoop D, De Korte J, Cobelens S, Kuipers M: Patient compliance and disease management in the treatment of psoriasis in the Netherlands. Dermatol. 2000, 200: 292-298. 10.1159/000018390.CrossRef
36.
go back to reference Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM: The risk of depression, anxiety and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010, 146: 891-895. 10.1001/archdermatol.2010.186.PubMedCentralPubMed Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM: The risk of depression, anxiety and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010, 146: 891-895. 10.1001/archdermatol.2010.186.PubMedCentralPubMed
37.
go back to reference Li WF, Wang P: Clinical Analysis of 47 Patients with Psoriasis Arthropathy Treated by Traditional Chinese Medicine Syndrome Differentiation and Integrative Medicine. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chin J Integ Trad West Med). 2008, 28: 928-931. Li WF, Wang P: Clinical Analysis of 47 Patients with Psoriasis Arthropathy Treated by Traditional Chinese Medicine Syndrome Differentiation and Integrative Medicine. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chin J Integ Trad West Med). 2008, 28: 928-931.
38.
go back to reference Zargari O: The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Experiment Dermatol. 2006, 31: 192-195. 10.1111/j.1365-2230.2005.02028.x.CrossRef Zargari O: The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Experiment Dermatol. 2006, 31: 192-195. 10.1111/j.1365-2230.2005.02028.x.CrossRef
39.
go back to reference Gan HF, Cai DH: Tongue Research Situation on Psoriatic Patient. Zhong GuoZhong Xi Yi Jie He Pi Fu Xing Bing Xue Za Zhi (Chin J Dermatol Venereol Integ Trad West Med). 2010, 9: 327-329. Gan HF, Cai DH: Tongue Research Situation on Psoriatic Patient. Zhong GuoZhong Xi Yi Jie He Pi Fu Xing Bing Xue Za Zhi (Chin J Dermatol Venereol Integ Trad West Med). 2010, 9: 327-329.
40.
go back to reference Zhang GZ, Wang P, Wang JS, Jiang CY, Deng BX, Li P, Zhao YM, Liu WL, Qu X, Chen WW, Zeng L, Zhou DM, Sun LY, Li RY: Study on the Distribution and Development Rules of TCM Syndromes of 2651 Psoriasis Vulgaris Cases [In Chinese]. Zhong Yi Za Zhi (J Trad Chin Med). 2008, 49 (10): 894-896. Zhang GZ, Wang P, Wang JS, Jiang CY, Deng BX, Li P, Zhao YM, Liu WL, Qu X, Chen WW, Zeng L, Zhou DM, Sun LY, Li RY: Study on the Distribution and Development Rules of TCM Syndromes of 2651 Psoriasis Vulgaris Cases [In Chinese]. Zhong Yi Za Zhi (J Trad Chin Med). 2008, 49 (10): 894-896.
41.
go back to reference Gudjonsson J, Thorarinsson A, Sigurgeirsson B, Kristinsson K, Valdimarsson H: Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. Br J Dermatol. 2003, 149: 530-534. 10.1046/j.1365-2133.2003.05552.x.CrossRefPubMed Gudjonsson J, Thorarinsson A, Sigurgeirsson B, Kristinsson K, Valdimarsson H: Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. Br J Dermatol. 2003, 149: 530-534. 10.1046/j.1365-2133.2003.05552.x.CrossRefPubMed
42.
go back to reference Mowad CM, Margolis DJ, Halpern AC, Suri B, Synnestvedt M, Guzzo CA: Hormonal influences on women with psoriasis. Cutis. 1998, 61 (5): 257-260.PubMed Mowad CM, Margolis DJ, Halpern AC, Suri B, Synnestvedt M, Guzzo CA: Hormonal influences on women with psoriasis. Cutis. 1998, 61 (5): 257-260.PubMed
43.
go back to reference Dika E, Bardazzia F, Balestria R, Maibach HI: Environmental factors and psoriasis. In Environmental factors in skin diseases. Curr Probl Dermatol. 2007, 35: 118-135.CrossRefPubMed Dika E, Bardazzia F, Balestria R, Maibach HI: Environmental factors and psoriasis. In Environmental factors in skin diseases. Curr Probl Dermatol. 2007, 35: 118-135.CrossRefPubMed
44.
go back to reference Scheibe M, Skutsch M, Schofer J: Experiments in Delphi methodology. The Delphi Method: Techniques and Applications. Edited by: Linstone HA, Turoff M. 1975, London: Addison-Wesley Publishing Company, Reading, MA, 262-287. Scheibe M, Skutsch M, Schofer J: Experiments in Delphi methodology. The Delphi Method: Techniques and Applications. Edited by: Linstone HA, Turoff M. 1975, London: Addison-Wesley Publishing Company, Reading, MA, 262-287.
45.
go back to reference Mullen PM: Delphi: myths and reality. J Health Organ Manag. 2003, 17 (1): 37-52. 10.1108/14777260310469319.CrossRefPubMed Mullen PM: Delphi: myths and reality. J Health Organ Manag. 2003, 17 (1): 37-52. 10.1108/14777260310469319.CrossRefPubMed
46.
go back to reference Sumsion T: The Delphi technique: an adaptive research tool. Br J Occup Ther. 1998, 61 (4): 153-156.CrossRef Sumsion T: The Delphi technique: an adaptive research tool. Br J Occup Ther. 1998, 61 (4): 153-156.CrossRef
47.
go back to reference Walker AM, Selfe J: The Delphi method: a useful tool for the allied health researcher. Br J Ther Rehabilitation. 1996, 3 (12): 677-680.CrossRef Walker AM, Selfe J: The Delphi method: a useful tool for the allied health researcher. Br J Ther Rehabilitation. 1996, 3 (12): 677-680.CrossRef
48.
go back to reference Mitroff II, Turoff M: Philosophical and methodological foundations of Delphi. The Delphi method: Techniques and applications. Edited by: Linstone HA, Turoff M. 1975, Reading MA: Addison-Wesley Publishing Co Mitroff II, Turoff M: Philosophical and methodological foundations of Delphi. The Delphi method: Techniques and applications. Edited by: Linstone HA, Turoff M. 1975, Reading MA: Addison-Wesley Publishing Co
49.
go back to reference Wild C, Torgersen H: Foresight in medicine: lessons from three European Delphi studies. Eur J Public Health. 2000, 10 (2): 114-119. 10.1093/eurpub/10.2.114.CrossRef Wild C, Torgersen H: Foresight in medicine: lessons from three European Delphi studies. Eur J Public Health. 2000, 10 (2): 114-119. 10.1093/eurpub/10.2.114.CrossRef
50.
go back to reference Turoff M: The design of a policy Delphi. Technol Forecast Soc Change. 1970, 1 (2): 149-171. Turoff M: The design of a policy Delphi. Technol Forecast Soc Change. 1970, 1 (2): 149-171.
Metadata
Title
Developing a diagnostic checklist of traditional Chinese medicine symptoms and signs for psoriasis: a Delphi study
Authors
Xuesong Yang
Virasakdi Chongsuvivatwong
Edward McNeil
Jianzhou Ye
Xiaoyong Ouyang
Enpin Yang
Hutcha Sriplung
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Chinese Medicine / Issue 1/2013
Electronic ISSN: 1749-8546
DOI
https://doi.org/10.1186/1749-8546-8-10

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