Self-reported Versus Physician-reported Severity of Chronic Hand Eczema: Concordance Analysis Based on Data from the German Chronic Hand Eczema Patient Long-Term Management Registry


  • Philipp Bentz Department of Occupational Dermatology, Dermatology clinic, Heidelberg University Hospital, Heidelberg, Germany
  • Christian Apfelbacher Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
  • Wilhelm Akst Privat practice, Prüm (Eifel), Germany
  • Sonja Molin Division of Dermatology, Department of Medicine, Queen’s University, Kingston, Canada
  • Andrea Bauer Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
  • Peter Elsner Privat practice for dermatology and allergology, SRH Hospital Gera, Germany
  • Vera Mahler Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
  • Ralph von Kiedrowski Focus practice for chronic inflammatory dermatoses, skin cancer and allergology and study center CMS GmbH, Selters (Westerwald), Germany
  • Jochen Schmitt Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
  • Elke Weisshaar Division of Occupational Dermatology, Dermatology clinic, Heidelberg University Hospital, Heidelberg, Germany



concordance, self-reported health, chronic hand eczema, patient-reported outcomes


Self-assessment of general health status has a significant influence on patient-related outcomes. The aims of this study were to investigate and compare the level of agreement between patients’ and dermatologists’ assessments of the severity of chronic hand eczema. From the German registry “German Chronic Hand Eczema Patient Long-Term Management Registry” (CARPE), 1,281 pairs of patients with chronic hand eczema and their dermatologists were included. Of these, 788 pairs served as a comparison 2 years after baseline. Concordance analyses found that complete concordance between patients’ and dermatologists’ assessments were 16.62% at baseline and 11.47% at follow-up. Overall, patients assessed their chronic eczema at baseline as more severe than did the dermatologists; whereas, at follow-up, patients assessed their condition as less severe than the dermatologists’ assessment. Bangdiwala’s B showed lower values of concordance for womens’ and older patients’ self-assessment with the dermatologists’ assessments. In conclusion, dermatologists should consider the patient’s perspective and the individual’s assessment of their chronic hand eczema in order to provide effective care in clinical practice.


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Berthold E, Weisshaar E. Therapie des Handekzems. Hautarzt 2019; 70: 790-796. DOI:

Carroll CL, Balkrishnan R, Feldman SR, Fleischer AB, Jr., Manuel JC. The burden of atopic dermatitis: impact on the patient, family, and society. Pediatr Dermatol 2005; 22: 192-199. DOI:

Kleyn CE, Barbarot S, Reed C, Losi S, von Arx LB, Robert C, et al. Burden of moderate to severe atopic dermatitis in adults from France, Italy, and the UK: patient-reported outcomes and treatment patterns. Dermatol Ther 2022; 12: 1947-1965. DOI:

Ofenloch RF, Weisshaar E. Epidemiologie des Handekzems in Deutschland. Ein Rückblick auf die letzten 10 Jahre Handekzemforschung in Deutschland. Hautarzt 2019; 70: 766-772. DOI:

Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, et al. Guidelines for diagnosis, prevention and treatment of hand eczema - short version. J Dtsch Dermatol Ges 2015; 13: 77-85. DOI:

Tian M, Chen Y, Zhao R, Chen L, Chen X, Feng D, et al. Chronic disease knowledge and its determinants among chronically ill adults in rural areas of Shanxi Province in China: a cross-sectional study. BMC Public Health 2011; 11: 948. DOI:

Slama-Chaudhry A, Golay A. Patient education and self-management support for chronic disease: methodology for implementing patient-tailored therapeutic programmes. Public Health Panor 2019; 5.

Feng Q, Zhu H, Zhen Z, Gu D. Self-rated health, interviewer-rated health, and their predictive powers on mortality in old age. J Gerontol B Psychol Sci Soc Sci 2016; 71: 538-550. DOI:

Geest TA, Engberg M, Lauritzen T. Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion. Scand J Prim Health Care 2004; 22: 146-151. DOI:

Wuorela M, Lavonius S, Salminen M, Vahlberg T, Viitanen M, Viikari L. Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up. BMC Geriatr 2020; 20: 120. DOI:

Baron-Epel O. Self-reported health. In: Anderson NB, editor. Encyclopedia of health and behavior. New York: SAGE Publications; 2004: p. 630-634.

Nielsen AB, Siersma V, Hiort LC, Drivsholm T, Kreiner S, Hollnagel H. Self-rated general health among 40-year-old Danes and its association with all-cause mortality at 10-, 20-, and 29 years' follow-up. Scand J Public Health 2008; 36: 3-11. DOI:

Zhu H, Feng Q, Gu D. Self-rated health and interviewer-rated health: differentials in predictive power for mortality among subgroups of Chinese elders. Int J Popul Stud 2016; 2: 74-91. DOI: DOI:

Eriksson HG, von Celsing AS, Wahlstrom R, Janson L, Zander V, Wallman T. Sickness absence and self-reported health a population-based study of 43,600 individuals in central Sweden. BMC Public Health 2008; 8: 426. DOI:

Linn BS, Linn MW. Objective and self-assessed health in the old and very old. Soc Sci Med Med Psychol Med Sociol 1980; 14A: 311-315. DOI:

Borawski EA, Kinney JM, Kahana E. The meaning of older adults' health appraisals: congruence with health status and determinant of mortality. J Gerontol B Psychol Sci Soc Sci 1996; 51: S157-170. DOI:

Desalvo KB, Muntner P. Discordance between physician and patient self-rated health and all-cause mortality. Ochsner J 2011; 11: 232-240.

Idler EL, Hudson SV, Leventhal H. The meanings of self-ratings of health: a qualitative and quantitative approach. Res Aging 1999; 21: 458-476. DOI:

Kivinen P, Halonen P, Eronen M, Nissinen A. Self-rated health, physician-rated health and associated factors among elderly men: the Finnish cohorts of the Seven Countries Study. Age Ageing 1998; 27: 41-47. DOI:

Klein R, Scherer J, Meyer F. Die Krankheit aus der Sicht von Patient und Arzt - wie beurteilen beide die Situation?. ZFA 2003; 79: 248-253. DOI:

van Doorn C. A Qualitative approach to studying health optimism, realism, and pessimism. Res Aging 1999; 21: 440-457. DOI:

Apfelbacher C, Molin S, Weisshaar E, Bauer A, Elsner P, Mahler V, et al. Characteristics and provision of care in patients with chronic hand eczema: updated data from the CARPE registry. Acta Derm Venereol 2014; 94: 163-167. DOI:

Apfelbacher C, Weiss M, Molin S, Bauer A, Mahler V, Schmitt J, et al. Which factors are associated with the use of systemic antihistamines in patients with chronic hand eczema? Results from the CARPE registry. J Eur Acad Dermatol Venereol 2016; 30: 50-56. DOI:

Apfelbacher CJ, Akst W, Molin S, Schmitt J, Bauer A, Weisshaar E, et al. CARPE: a registry project of the German Dermatological Society (DDG) for the characterization and care of chronic hand eczema. J Dtsch Dermatol Ges 2011; 9: 682-688. DOI:

Apfelbacher CJ, Ofenloch RF, Weisshaar E, Molin S, Bauer A, Mahler V, et al. Chronic hand eczema in Germany: 5-year follow-up data from the CARPE registry. Contact Dermatitis 2019; 80: 45-53. DOI:

Ruppert L, Apfelbacher C, Molin S, Bauer A, Mahler V, Schmitt J, et al. Itching in patients with chronic hand eczema: data from the CARPE registry. Dermatology 2014; 229: 146-153. DOI:

Shankar V, Bangdiwala SI. Behavior of agreement measures in the presence of zero cells and biased marginal distributions. J Appl Stat 2008; 35: 445-464. DOI:

Bangdiwala SI. Graphical aids for visualizing and interpreting patterns in departures from agreement in ordinal categorical observer agreement data. J Biopharm Stat 2017; 27: 77-783. DOI:

Cicchetti DV, T A. A new procedure for assessing reliability of scoring EEG sleep recordings. Am J EEG Technol 1971; 11: 101-110. DOI:

Kassambara A. Weighted Kappa in R: For Two Ordinal Variables. 2018 accessed 21.02.2023,

Eubanks D. (Re)visualizing rater agreement: beyond single-parameter measures. J Writ Anal 2017; 1: 276-310. DOI:

Bangdiwala SI, Shankar V. The agreement chart. BMC Med Res Methodol 2013; 13. DOI:

Wickham H, Averick M, Bryan J, Chang W, McGowan L, François R, et al. Welcome to the Tidyverse. J Open Source Softw 2019; 4: 1686. DOI:

Meyer D, Zeileis A, Hornik K, Gerber F, Friendly M. vcd: Visualizing categorical data: R package version 1.4-8; 2020.

Munoz SR, I BS. Interpretation of kappa and B statistics measures of agreement. J Appl Stat 1997; 24: 105-112. DOI:

Cvetkovski RS, Jensen H, Olsen J, Johansen JD, Agner T. Relation between patients' and physicians' severity assessment of occupational hand eczema. Br J Dermatol 2005; 153: 596-600. DOI:

van Coevorden AM, van Sonderen E, Bouma J, Coenraads PJ. Assessment of severity of hand eczema: discrepancies between patient- and physician-rated scores. Br J Dermatol 2006; 155: 1217-1222. DOI:

Wei W, Anderson P, Gadkari A, Blackburn S, Moon R, Piercy J, et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey. Am J Clin Dermatol 2017; 18: 825-835. DOI:

Griffiths C, Naldi L, Augustin M, Romiti R, Guevara-Sanginés E, Howe T, et al. Discordance between patients with psoriasis and their physicians in assessing disease severity, psoriasis-related symptoms and disease control: results from a large observational physician and patient survey. J Am Acad Dermatol 2017; 76: AB102. DOI:

Rief W, Glombiewski JA. Erwartungsfokussierte Psychotherapeutische Interventionen (EFPI). Verhaltenstherapie 2016; 26: 47-54. DOI:

Boerma T, Hosseinpoor AR, Verdes E, Chatterji S. A global assessment of the gender gap in self-reported health with survey data from 59 countries. BMC Public Health 2016; 16: 675. DOI:

Caroli E, Weber-Baghdiguian L. Self-reported health and gender: the role of social norms. Soc Sci Med 2016; 153: 220-229. DOI:

Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013; 111: 52-58. DOI:

Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL, 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10: 447-485. DOI:

Mollerup A, Johansen JD. Response shift in severity assessment of hand eczema with visual analogue scales. Contact Dermatitis 2015; 72: 178-183. DOI:



How to Cite

Bentz, P., Apfelbacher, C., Akst, W., Molin, S., Bauer, A., Elsner, P., Mahler, V., von Kiedrowski, R., Schmitt, J., & Weisshaar, E. (2023). Self-reported Versus Physician-reported Severity of Chronic Hand Eczema: Concordance Analysis Based on Data from the German Chronic Hand Eczema Patient Long-Term Management Registry. Acta Dermato-Venereologica, 103, adv00884.





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