J Korean Med Ophthalmol Otolaryngol Dermatol 2018;31(4):31-41 pissn 1738-6640 eissn 2234-4020 http://www.ood.or.kr http://dx.doi.org/10.6114/jkood.2018.31.4.031 Original Article / 원저다빈도피부질환에대한국내외한의학논문에서평가도구사용현황에대한고찰 박소영 1,3 강민서 1,2 김민희 1 곽재영 1 최인화 1,4* 1 강동경희대학교병원한방안이비인후피부과박소영 ( 전문수련의 ), 강민서 ( 전임의 ), 김민희 ( 임상조교수 ), 곽재영 ( 전문수련의 ), 최인화 ( 교수 ) 2 세명대학교한의과대학안이비인후피부과교실, 3 경희대학교일반대학원임상한의학과 4 경희대학교한의과대학안이비인후피부과 A Review of Assessment Tools in Traditional Medicine on the High Frequent Skin Diseases So-Young Park 1,3 Min-Seo Kang 1,2 Min-Hee Kim 1 Jae-Young Kwak 1 In-Hwa Choi 1,4* 1 Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea 2 Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Semyung University 3 Department of Clinical Korean Medicine, Graduate school, Kyung Hee University 4 Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University Abstract Objectives : The purpose of this study is to establish the basis of the assessment tools that can be used for the diagnosis and assessment of skin diseases by reviewing the present status of the assessment tools used in domestic and overseas traditional medicine papers for the past five years. Methods : This study is based on analysis of papers on clinical trials about atopic dermatitis, psoriasis, acne, urticaria published from 1st July 2013 to 30th June 2018. The papers were searched from Oriental Medicine Advanced Searching Integrated System(OASIS), Korean Traditional Knowledge Portal(KTKP), Pubmed, MEDLINE. Results : 40 articles on atopic dermatitis, 34 articles on psoriasis, 26 articles on acne and 10 articles on urticaria were selected. Among them, 38 articles(90%), 20 articles(85%), 22 articles(85%) and 5 articles(50%) used assessment tools in order. Conclusions : SCoring Atopic Dermatitis(SCORAD), objective SCORing of Atopic Dermatitis index(osi), Eczema Area and Severity Index(EASI) were used in studies on atopic dermatitis. In the case of psoriasis, The c 2018 the Society of Korean Medicine Ophthalmology & Otolaryngology & Dermatology This is an Open Access journal distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/license/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 31
Psoriasis Area and Severity Index(PASI) was used in most papers. In the study on acne, most of Korean papers used Korean Acne Grading System(KAGS), but in the overseas papers, various assessment tools were used. In the case of urticaria, the rate of use of the assessment tool was the lowest, but the assessment tool used was unified by Urticaria Activity Score(UAS). Since skin diseases can cause stress and a decrease in quality of life, the quality of life should be taken into account when evaluating treatment effects. Key words : Assessment tools; Atopic dermatitis; Psoriasis; Acne; Urticaria Ⅰ. 서론 질환의중증도에대한정량적이고객관적인측량은치료에의한경과를비교적객관적으로파악하고, 치료효과를평가할수있는핵심요소로질환의치료와관리에있어기본이된다. 특히피부질환에서는질환의특성상겉으로나타나는피부증상의정도를임상의의판단이나환자가느끼는정도에따라평가하는방법이주로사용되고있다. 이는평가자의주관이개입할여지가많다는한계가있어객관적인측정방법에대한개발과연구가지속되었다. 그결과다양한피부질환에서평가방법으로많은평가도구들을사용하고있는데, 평가도구는평가방법중하나의수단으로척도, 설문지등이있고, 그외의평가방법으로는면담, 육안관찰등이있다. 평가지표는어떤목표를두고현재수행되고있는과정의수준이나정도를나타내는것으로객관적, 주관적지표가있다. 예를들어소양감을평가할때 VAS 를사용한다면, 평가도구는 VAS 이고환자가호소하는소양감의정도는주관적평가지표에해당한다. 현재까지피부질환에관한한의학논문에서의평가도구는특정질환의한의학적치료동향연구에서부분적으로언급된것이대부분이다 1,2). 평가방법을중점적으로다룬연구는많지않으나대부분아토피피부염에관한것이었으며 3-5), 그외에이등 6) 이두드러기의새로운평가도구를제안한연구가있었다. Corresponding author : Inhwa Choi, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Korea. (Tel: 02-440-6235, E-mail: inhwajun@khnmc.or.kr) Received 2018/10/10 Revised 2018/11/1 Accepted 2018/11/8 신뢰할만한평가도구사용의보편화혹은평가도구의개발을위해서는실제임상및연구에서평가도구의사용현황파악이필요할것으로생각되었다. 이에본연구에서는 2017년한방의료기관에서진료한다빈도피부질환을선정해평가도구의사용현황을살펴보고분석해보고자하였다. Ⅱ. 연구방법 1. 검색방법 2017년한방의료기관을내원한환자중다빈도 500순위이내의질환 7) 에해당하는피부질환중아토피피부염, 건선, 여드름, 두드러기를대상으로하였다. 검색기관은전통의학정보포털, 한국전통지식포털, PubMed, MEDLINE으로하였다. 1) 전통의학정보포털 (Orental Medicine Advanced Searching Integrated System, OASIS, http://oasis.kiom.re.kr), 한국전통지식포탈 (Korean Traditional Knowledge Portal, KTKP, http://www.koreantk.com) 검색어 : 아토피, 건선, 여드름, 두드러기검색일 : 2018.07.13 2) Pubmed 검색어 : atopic dermatitis [ti] AND ("complementary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR "herbal medicine" OR "botanical" OR "traditional chinese 32
박소영외 4 인 : 다빈도피부질환에대한국내외한의학논문에서평가도구사용현황에대한고찰 medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), psoriasis[ti] AND ("complementary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR "herbal medicine" OR "botanical" OR "traditional chinese medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), acne[ti] AND ("complementary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR "herbal medicine" OR "botanical" OR "traditional chinese medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), urticaria[ti] AND ("traditional chinese medicine" OR "acupuncture" OR "complementary medicine" OR "herb" OR "herbal" OR "Korean medicine" OR "Kampo medicine" OR "TCM") 검색일 : 2018.7.13 "herbal medicine" OR "botanical" OR "traditional chinese medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), urticaria AND ("traditional chinese medicine" OR "acupuncture" OR "comple- mentary medicine" OR "herb" OR "herbal" OR "Korean medicine" OR "Kampo medicine" OR "TCM") 검색일 : 2018.7.13 2. 문헌선택해당검색기관에서 2013년 7월 1일부터 2018년 6 월 30일에발행된논문을대상으로하였다. 중복된논문과원문열람이불가능한논문을 1차적으로배제하고제목, 초록및필요시원문을검토하여질환과관계없는논문과정식학술논문이아닌것, 실험연구및리뷰논문을배제하였다. 3) MEDLINE 검색어 : atopic dermatitis AND ("complementary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR "herbal medicine" OR "botanical" OR "traditional chinese medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), psoriasis AND ("complementary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR "herbal medicine" OR "botanical" OR "traditional chinese medicine" OR "acupuncture" OR "TCM" OR "CAM" OR "Korean medicine" OR "kampo medicine" OR "oriental medicine"), acne AND ("comple- mentary medicine" OR "complementary alternative medicine" OR "herb" OR "herbal" OR Fig. 1. Flow Diagram of the Study 33
Ⅲ. 결과 1. 논문검색결과 검색결과상기문헌선정제외기준에따라최종적으로아토피 40편, 건선 34편, 여드름 26편, 두드러기 10편의논문이선정되었다 (Fig. 1). 2. 주요주제분석에사용된약어목록 (Table 1) 3. 아토피피부염아토피로검색결과선정된한방논문 40편중 SCORAD 를평가도구로사용한논문이 22편으로가장많았으며, 그다음으로많이사용된평가도구는 OSI가 9편, EASI가 5편이었다. 이중평가도구를하나만사용한논문은 SCORAD 가 6편, OSI가 5편으로총 12편이었다. 평가도구를임의로만들어사용한논문 1편, 평가를시행하였으나평가도구에대한언급이없는논문 3편이었다. 10편의논문에서 SCORAD 와 Table 1. List of Abbreviations Atopic dermaitis EASI KiFDA -HM-AD OSI POEM SCORAD TEWL TIS Psoriasis BSA NPASI PASI PGA TSS Acne AS-QoL BIDQ CADI ECCA GASC GAGS KAGS KCADI QGASC Urticaria CU-Q2oL U-AIM UAS Used in common CDLQI DLQI IGA VAS Eczema Area and Severity Index Guidelines of clinical trials using herbs for atopic dermatitis objective SCORing of Atopic Dermatitis index Patient-Oriented Eczema Measure SCoring Atopic Dermatitis Transepidermal Water Loss Three Item Severity Body Surface Area Nail Psoriasis Severity Index The Psoriasis Area and Severity Index Physician Global Assessment Severity signs Total Score Acne Specific Quality of Life Body Image Disturbance Questionnaire Cardiff Acne Diability Index Echelle d' evaluation Clinique des Cicatrices d' Acne Global Acne Scarring Classification Global Acne Grading System Korean Acne Grading System Cardiff Acne Disability Index in Korea Qualitative Global Acne Scarring Grading System Chronic Urticaria Quality of Life Questionnaire Urticaria Activity and Impact Measure Urticaria Activity Score Children's Dermatology Life Quality Index Dermatology Life Quality Index Investigator's Global Assessment Visual Analogue Scale 34
박소영외 4 인 : 다빈도피부질환에대한국내외한의학논문에서평가도구사용현황에대한고찰 함께소양감을평가하기위해 VAS를사용하였다. 이외에삶의질설문지인 skindex-29 와 DLQI/CDLQI 를사용한논문이 5편있었고, 얼굴등특정부위만관찰하기위해 IGA를사용한논문이 1편, 평가부위를제한하여 modified SCORAD index를평가한논문 1편이있었다. 또평가도구외에질환의중증도를측정하기위해사용된지표로는피부pH, 피부수분함유량, TEWL, 피부온도, DITI가있었다 (Table 2). 4. 건선 건선에대한한방논문에서가장많이사용된평가도구는 PASI로 34편중 29편에서사용하였다. 국내한방논문은 18편중 18편에서 PASI를평가도구로사용하고있었고그중 5편의논문에서는소양감에대한평가도함께이루어졌다. 해외한방논문 16편중 11편에서 PASI를사용하였는데, 이중 1편의논문에서는손톱건선을대상으로하여 NPASI 를사용하였다. 11편중 PASI만단독으로사용한논문은 8편이었으며, 2편의논문에서는 DLQI 와 SF-36 를, 1편의논문에서는 BSA와 TSS를함께사용하였다. PASI를사용하지않은 5편의논문중 1편에서는 VAS, BSA, DLQI, SF-36 을사용하였고, 1편에서는 local psoriasis Table 2. Analysis of the Reports on Atopic Dermatitis Assessment Tools Number of articles SCORAD 23 VAS 9 OSI 9 EASI 5 DLQI/CDLQI 4 Skindex-29 2 IGA 1 TIS 1 Others 1 Notes Simplified diagnosis criteria of KiFDA-HM-AD severity index 를사용하였으며, 나머지 3편에서는평가도구를제시하지않았다 (Table 3). Table 3. Analysis of the Reports on Psoriasis Assessment Tools Number of articles PASI 29 VAS 5 BSA 3 DLQI 3 SF-36 3 PGA 1 TSS 1 Others 5. 여드름 2 1 Notes 0~3 points, for sleep disorder local psoriasis severity index (only extremities) 여드름에대한국내외한방논문 26편중 KAGS 를평가도구로사용한논문이 9편으로가장많았고, 여드름흉터의경우 GASC 와 ECCA 가총 4편중 2편의논문에서사용되었다. 여드름에대한국내한방논문 10편중 8편의논문에서 KAGS 를평가도구로사용하였으며, 이중 KAGS 만단독으로사용한논문은 6편이었다. 1편의논문에서는 KCADI 를, 1편의논문에서는 skindex-29, BIDQ를함께사용하였으며, 진단기기를활용하여치료전후의상태를관찰하였다. 여드름흉터에대한논문 2편에서는 GASC 와 ECCA 를평가도구로병용하였고, 1편에서는 QGASC 와함께 PGA를사용하였다. 해외한방논문 12편중가장많이사용된평가도구는 GAGS 로 3편에서사용되고있었으며, KAGS 를사용한논문 1편은한국인을대상으로한연구였다. 평가도구하나만을사용한논문은총 5 편으로 IGA 3편, GAGS 1편, Leeds acne grading system 1편이었다. 이외에기존에개발된평가도구가아닌임의의평가지표를사용하였거나진단기기를통해평가를시행한논문이각각 1편씩있었다 (Table 4). 35
Table 4. Analysis of the Reports on Acne Assessment Tools Number of articles KAGS 9 GAGS 5 IGA 4 VAS 3 ECCA 2 GASC 2 Leeds Acne Grading 2 System the Number of acne lesions 2 Acne-QoL 1 ASQoL 1 Assessment of QoL-8dimen 1 sion instrument BIDQ 1 CADI 1 DLQI 1 KCADI 1 Skindex-29 1 QGASC 1 Using Device 6. 두드러기 2 Notes Papules, Pustules Comedones, Papules, Pustules, Cysts, Nodules ECO SKIN (tone, flatness, anti-aging) Dermavision-pro (level of erythema) 가장많이사용된평가도구는 UAS로총 10편의논문중 5편에서사용되고있었다. 국내한방논문에서는 7편중 4편에서 UAS를사용하고있고, 나머지 3편에서는임의로평가기준을정하여사용하였다. 해외한방논문에서는 3편중 1편에서 UAS를사용하였고, 1편에서는평가도구대신혈액검사결과로치료전후를비교하였고, 1편에서는평가를시행하였으나어떤평가도구를사용하였는지에대한언급은없었다. UAS만단독으로평가도구로사용한논문은총 3편이었으며, 2편에서는 CU-Q2oL 설문지를함께사용하였다 (Table 5). Table 5. Analysis of the Reports on Urticaria Assessment Tools Number of articles UAS 5 CU-Q2oL 2 Others 3 Ⅳ. 고찰및결론 Notes - Frequency, Duration, Area, Recurrence - Frequency, Duration, Number, Pruritus, Times of taking anti-histamines - Pruritus, Frequency, Duration 평가란치료를위해필요한정보를얻고이를해석하는과정이며, 평가의주된목적은주어진상황과시간안에대상자에대한정확한정보를얻는것이다. 치료현장에서환자의전체적인평가과정중평가도구를사용하는부분은일부분에속하나표준화된평가도구의사용은평가결과의정확성과신뢰도를높여주며, 치료전후의효과를객관적으로비교할수있고, 연구의기초자료로활용할수있다는이점이있다 8). 표준화된평가도구는타당도, 신뢰도, 민감도등이검증된것을말하며, 이러한검증이이루어진평가도구의사용은연구간결과비교를용이하게하며연구결과에대한신뢰도를증가시킬수있다. 이에한방의료기관에서진료한다빈도피부질환중임상연구에서의평가도구사용현황을알아보고자본연구를진행하였다. 그결과아토피피부염총 40편중 36편, 건선 34편중 29편, 여드름 26편중 22편, 두드러기 10편중 5편에서평가도구를사용하고있음을확인할수있었다. 네질환모두에서평가도구의사용이저조하다고볼수는없었으나질환별로비교적통일된평가도구가사용되는경우도있었고, 그렇지않은경우도있었다. 36
박소영외 4 인 : 다빈도피부질환에대한국내외한의학논문에서평가도구사용현황에대한고찰 아토피피부염의경우기존에개발된 28개의중증도평가도구중타당도, 신뢰도, 민감도가검증된평가도구중하나인 SCORAD 9) 를가장많이사용하고있었으나그외 OSI, EASI, TIS, IGA 등의다양한평가도구들도활용되고있음을확인할수있었다. SCORAD 는 1993년 European Task Force on Atopic Dermatitis 에의해개발된평가도구로최근까지가장많이이용되고있으며, 아토피피부염의정도를면적, 중증도, 주관적증상세가지로분류하여평가하는방법이다. 면적은인체를 9등분하여각부위별몇 % 에병변이있는지를평가하고, 중증도는전체부위의 6가지상태를각각 0-3점으로평가하고, 주관적증상은소양감과수면장애로평가하며, 연구의목적에따라변형되어이용되기도한다 4). 많은연구에서 SCORAD 를사용하였고, 이에대한연구가많이이루어져있어 SCORAD 는아토피피부염의적절한평가도구로권장받고있으며 9), 이는 SCORAD를가장많이사용하고있다는본연구의결과와도일치한다. 아토피피부염에관한 40편의논문중평가도구를사용하지않았거나평가방법에대한언급이없는논문은 2편에불과하여대다수의논문에서평가도구를통해치료경과를평가하고있음을알수있었다. 한편, 두번째로많이사용되었던 OSI는영유아환자에대한주관적증상의판단이모호할수있는기존 SCORAD index 의한계를보완한것으로, OSI 사용시연구결과간비교가용이하여 OSI의사용을권장하는연구도있다. 5편의논문에서사용된 EASI는병변의범위에중점을둔것으로, 아토피피부염의경우범위를정확하게측정하기어렵다는한계가있다 10). 또한, 아토피피부염의증상에중점을둔평가도구외에 Skindex-29 와 DLQI/CDLQI와같은삶의질설문지를병용하였고, 평가지표로혈액검사수치를측정해치료효과의평가에참고한논문들이있었다. 이는한가지평가도구만으로아토피피부염의모든증상과환자의상태를평가하는데에는한계가있음을보여주는결과이다. 향후평가도구의통일을위해기 존평가도구의활용방안, 보완점을비롯하여부차적으로함께사용할수있는평가도구또는지표등에대한고찰도필요할것으로생각된다. 건선의경우민감도, 신뢰도, 타당도가검증되어사용이권장되고있는 PASI 가약 85% 의논문에서사용되고있음을확인할수있었다. PASI 는피부를 4개의부위로나누고각부위의증상 ( 홍반, 유병기간, 인설정도 ) 과증상범위를평가하여값을계산하는것이다 11). 그러나손발바닥, 접힌부위피부및두피, 조갑부위는적용하기힘들다는단점이있고, 증상이 10% 이하인경우민감도가떨어진다는한계가있어이를보완하기위해 PGA 혹은 BSA의병용이권장되고있다 12). PASI 에비해 PGA, BSA는방법이간편해임상현장에서많이사용되고있으며, PASI 는연구에서유효성판정에많이사용된다 13). 건선에대한논문중 PASI 와함께 PGA 혹은 BSA를병용한논문은 3편으로 PASI 를단독으로사용하는경우가대부분임을알수있었는데, 앞서기술한바와같은 PASI 의한계를보완하기위해서 PGA 혹은 BSA와같은다른평가도구의병용을적극적으로고려해볼수있겠다. 또한, NPASI 와같이 PASI 를적용하기힘든부위에발생한건선을평가할수있는도구가개발된다면보다세밀하고정확한평가가이루어질수있을것으로생각된다. 여드름의경우 18개의평가도구가개발되어있으나국제적으로통용되는평가도구는없으며각연구마다서로다른평가도구들이사용되고있었다. 여드름및여드름흉터치료에대한국내한방논문은 10편중 10편 (100%), 해외한방논문은 12편중 9편 (75%) 으로국내에서비교적더많이평가도구를사용하고있었다. 특히, 해외한방논문에서는 9편의논문에서 5 가지의평가도구를사용한것으로보아여드름에대한평가도구가통일되지않고사용되고있음을알수있었다. 이는여드름이면포, 홍반성구진, 농포, 결절, 반흔등다양한형태로나타날수있고, 병변의크기나밀집상태, 염증의정도와병의경과및치료반 37
응역시다양하여포괄적이고정확하며편리한여드름중증도평가가어렵다 14) 는점을반영하는것으로볼수있다. 최근에는이러한한계를극복하기위해진단기기를사용하여평가의객관성을높이고자하는움직임이있으며 15-17), 본연구에서도 2편의논문에서진단기기를활용하였음을확인할수있었다. 그중한편의논문에서는진단기기를통해여드름의홍반정도의변화를평가지표로삼아치료의경과를판단하였고, 한편의논문에서는여드름흉터의치료에있어피부톤, 편평도, 항노화항목을측정하여중증도를평가하였다. 진단기기를사용하면객관적이고신뢰도높은평가가가능하다는장점이있으나다만병변의종류에따라중증도를반영할수있는항목에대한고찰및관찰하고자하는평가항목통일에대한논의가선행되어야할것이다. 또평가자가직접시행하는평가방법과평가기기사용시의비용대비효과, 기계간결과값의차이를고려한참고치에대한논의가필요할것으로생각된다. 한편, 여드름흉터의경우논문 4편중 2편에서 GASC 를사용하였는데, GASC 는병변의개수, 흉터의형태, 중등도에따라여드름흉터를정량적으로평가하는도구이다 18). 이러한평가방법은병변의개수와종류를중점적으로관찰한다는특성상평가자의숙련도에영향을받을수있어평가도구선정시재현성을고려해야할것이다. 두드러기의경우임상연구에서사용된평가도구는 UAS로비교적통일되어있었으나네질환중가장낮은평가도구사용비율을보였다. 이는두드러기의증상이지속적이지않으며, 나타나는시기가일정하지않아내원당시증상이없는경우가있고, 주된증상인소양감은타피부질환에비해증상강도판정에있어환자의주관이개입될여지가많아임상의가환자의상태를일관되게평가하는데어렵다는점이반영된결과로보인다. 다만, 두드러기에관한임상연구는네질환중선정된논문의수가가장적어평가도구사용동향을반영하는데한계가있을것으로생각된다. 한편, 두드러기에대한논문에서가장많이사용된평가도구인 UAS는하루평균발생한팽진의개수와가려움증의심한정도를각각 0-3점까지측정하여두항목점수를합하여총 0-6점까지의점수로계산하는것이다 19). 유럽을비롯한미국알레르기학회, 국내만성두드러기전문가의견서에서 UAS의사용을권고하고있으며, 환자의상태파악, 약제간효과비교등을위해임상연구에서도흔히사용되고있다 19,20). 그러나 UAS는지도상병변의경우개수파악이애매하며, 환자스스로작성한다는점에서평가의정확성이떨어질수있다. 이러한한계를극복하기위해처음 UAS 시행시임상의또는연구자가환자에게평가의기준이되는증상에대해자세히설명하고, 참고할수있는사진을첨부하는방안등을생각해볼수있다. 또한, UAS의한계를보완할만한새로운평가도구를개발하려는노력이있어왔는데, 한연구에서는새로운평가도구를 UAS와비교하여증상및환자의삶의질을반영하는정도는비슷하지만순응도가 UAS에비해낮아 UAS를사용하는것이더낫다고보고 21) 하였다. 또다른연구에서는 UAS의항목에혈관부종, 이로인한괴로움, 수면및일상생활에의방해, 복약혹은연고사용등의처치에대한항목을더한새로운평가도구인 U-AIM 을개발하고, UAS에비해증상의변화에대해민감하게반응하고, 타당도가높다고보고하였다 22,23). 국내에서도 UAS 항목에팽진의발생빈도와지속시간, 항히스타민제복용횟수를더한새로운평가도구를제안하였다 6). 피부질환은병변이바깥으로드러난다는특성상스트레스의원인이되기도하며, 대인관계에도영향을미칠수있다. 더불어소양감으로인한일상생활의방해및수면불량등삶의질을저하시킨다. 대표적으로건선환자들은심각한정신적인문제를동반한다는것이밝혀졌으며 24), 중등증이상의건선환자에서는정서적불안과우울증, 자살사고까지이어진다는보고 25) 도있다. 또, 정신적인문제외에도가려움증과이로인한수면불량으로인한삶의질저하가동반되기 38
박소영외 4 인 : 다빈도피부질환에대한국내외한의학논문에서평가도구사용현황에대한고찰 도한다 26) 는것이밝혀졌다. 이러한점에서피부질환의중증도평가시증상자체에대한평가외에삶의질에대한평가의필요성이강조되고있고본연구에서도네질환모두삶의질평가지가평가에활용되고있는것을확인할수있었다. 이상한방의료기관에내원한다빈도피부질환을대상으로최근 5년간국내외에서발표된한방논문에서의평가도구사용실태에대해살펴보았다. 다만본연구는검색과정에서누락된연구가존재할가능성을배제할수없다는한계가있다. 즉, 국외논문검색엔진으로사용된 PubMed 와 MEDLINE 에서는검색되지않는중국, 일본을포함한아시아권국가내한방관련논문상당수가대상에서누락되었을것으로생각된다. 따라서향후아시아권에서발표된한방논문에서의평가도구사용을살펴본다면보다정확한경향을파악할수있을것으로기대된다. 감사의말씀 본연구는보건복지부한의약선도기술개발사업의지원에의하여이루어진것임. (HI12C1889, HI13C0530) ORCID Soyoung Park (https://orcid.org/0000-0003-1799-1544) Minseo Kang (https://orcid.org/0000-0003-4604-1388) Minhee Kim (https://orcid.org/0000-0002-6593-2410) Jaeyoung Kwak (https://orcid.org/0000-0001-5948-874x) Inhwa Choi (https://orcid.org/0000-0001-7416-2772) References 1. Hong SH. Reviewing Research on Korean medical treatment of Psoriasis. J Korean Med Ophtalmol Otolaryngol Dermatol. 2013;26(4):26-42. 2. Kim JH, Park SY, Rhee DH, Kim JS, Choi JH. The Review on th Acne Related Articles Published in the Journal of Korean Medicine Ophtalmology, Otolaryngology & Dermatology. J Korean Med Ophthalmol Otolaryngol Dermatol. 2014;27(3):26-39. 3. Son BK, Choi IH. Research of Pattern identification and Outcome Measurement in Atopic Dermatitis. J Korean Med Ophtalmol Otolaryngol Dermatol. 2008;21 (3):150-65. 4. Seo JM, Kim SC, Hwang SY, Hwang BM, Jee SY. A study on the Severity Scoring Systems of Atopic Dermatitis; comparison, Analysis and Establishment of childhood patients in Oriental Medicine J Korean Oriental Pediatrics. J Korean Oriental Pediatrics. 2006;20(2):1-14. 5. Yoon HJ, Yoon JW, Yoon SW, Ko OS. A study on the Severity Scoring Systems of Atopic dermatitis; Comparision, Analysis and Establishment. J Korean Oriental Med. 2002;23(4):15-26. 6. Lee GY, Kim HJ. A study on the Severity Scoring Systems of Atopic Dermatitis ; comparison, Analysis and Establishment of childhood patients in Oriental Medicine. J Korean Oriental Med. 2005;26(2):25-31. 7. High frequency morbidity statistcs. Health care Big data Open system. 2017.Available 39
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