Background The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks. Objective To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user‐friendliness and timing. Methods In this study, we compared the reliability of three different methods: (i) the fingertip unit calculated by the 1% hand rule; (ii) a picture‐based tool [termed Cutaneous Inflammatory Disease Extent Score (CIDES)]; and (iii) a digital drawing tool. Eleven observers scored 40 patients with psoriasis and eczema to assess the inter‐rater and intrarater reliability. Timing was automatically recorded, and user‐friendliness was investigated by a questionnaire. Results An excellent intraclass correlation (ICC) was found for both inter‐rater agreement and intrarater agreement for the picture‐based tool (ICC = 0.92 and ICC = 0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased inter‐rater variability although an excellent intrarater agreement was found (ICC = 0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability, and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 s). Conclusion A picture‐based method offered the most advantages (in terms of reliability, speed and user‐friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.

Background:The management of vitiligo is guided by the assessment of disease activity. However, this assessment is hampered by the absence of a highly feasible and reliable single marker to evaluate activity. Furthermore, the need for an objective, easy, preferably noninvasive marker is further stressed by the increased amount of research performed on new treatment strategies for vitiligo.Objectives: In this review, the available research on clinical signs linked to disease activity, and biomarkers in tissues and blood are summarized.Results: In the group of clinical signs, the Koebner phenomenon has the strongest evidence of an association with disease activity, while confetti-like depigmentation is gaining importance and seems to outweigh this role. For the tissue markers, the most evidence is available for histopathological findings, such as epidermal spongiosis with vacuolar degeneration in the basal cells and inflammatory infiltrate. Circulating biomarkers such as interleukin-1β (IL-1β), IL-17, interferon-γ, tumor growth factor-β, soluble cluster of differentiation 25, autoantibodies, and oxidative stress markers show the most promising results. Nevertheless, none of them are currently regarded as the gold standard.Discussion: In conclusion, we encourage researchers to investigate various biomarkers and clinical signs in their trials in a standardized manner to get insight into their exact value, so they can be used to optimize treatment selection, gain insight into the disease, and predict future disease progression.

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