Supplementary Material for: Fric Test Revisited: A Suggestion for a New Scoring System and Its Correlation with Urticaria Control Test and Dermatology Life Quality Index

<b><i>Background:</i></b> Fric test is a useful tool for the diagnosis and threshold testing for symptomatic dermographism. When threshold testing is not available, Urticaria Control Test (UCT) and Dermatology Life Quality Index (DLQI) might be used to assess disease control and quality of life (QoL) impairment, respectively. <b><i>Objectives:</i></b> In this study, we aimed to describe a new scoring system for the Fric test and evaluate the correlations of Fric scores with UCT, DLQI, and other disease activity assessment scores. <b><i>Method:</i></b> Provocation test with Fric Test 4.0 was performed in all patients at referral and at the 4th week. We considered a 4-grade rating score for Fric Test (0–4) [Total Fric Score (TFS)]. A positive response with all of the four pins suggested severe dermographism (TFS = 4), while a wheal with only the largest pin (4.5 mm) was considered as milder disease (TFS = 1). Treatment responses were evaluated with Fric Test 4.0, UCT, patient’s global assessment of disease severity (PatGA-VAS), the physician’s global assessment of disease control (PhyGA-VAS), and DLQI at baseline and at the 4th week of treatment. The correlations of TFS with UCT, DLQI, PatGA-VAS, PhyGA-VAS at baseline as well as the changes in the mean scores after treatment (week 4) were performed. <b><i>Results:</i></b> The mean UCT and DLQI scores were 8.69 ± 3.40 and 7.88 ± 6.02 at the first visit. At the second visit, TFS decreased from a mean of 2.79 ± 1.68 to 1.91 ± 1.85 (<i>p</i> &lt; 0.001), and UCT scores and PhyGA-VAS were increased (<i>p</i> &lt; 0.001), while DLQI scores, PatGA-VAS, and pruritus scores decreased significantly (<i>p</i> = 0.002; <i>p</i> = 0.001; <i>p</i> = 0.012). There was a positive correlation between TFS and pruritus scores (<i>r</i> = 0.378) and DLQI scores (<i>r</i> = 0.392). TFS was found to have a negative correlation with UCT score (<i>r</i> = –0.283) and PhyGA-VAS (<i>r</i> = –0.347). <b><i>Conclusions:</i></b> This new Fric scoring system allows comparison with other tools and shows moderate correlations with most of the tools. Using disease-specific tools is recommended since they provide a subjective evaluation of disease severity, QoL impairment, and disease control.

<b><i>背景：</i></b> 弗雷克试验（Fric test）是用于症状性皮肤划痕症诊断及阈值检测的有效工具。当无法开展阈值检测时，可分别采用荨麻疹控制试验（Urticaria Control Test, UCT）与皮肤病生活质量指数（Dermatology Life Quality Index, DLQI）评估疾病控制情况与生活质量（quality of life, QoL）受损程度。<b><i>目标：</i></b> 本研究旨在构建一种全新的弗雷克试验评分系统，并评估弗雷克试验总评分（Total Fric Score, TFS）与UCT、DLQI及其他疾病活动度评估量表的相关性。<b><i>方法：</i></b> 所有患者在初诊及治疗第4周时均接受弗雷克试验4.0（Fric Test 4.0）激发试验。本研究对弗雷克试验采用4级评分量表（0~4分），记为弗雷克试验总评分（TFS）：若全部4个针点均出现阳性反应，则判定为重度皮肤划痕症（TFS=4）；若仅最大针点（4.5mm）处出现风团，则判定为病情较轻（TFS=1）。分别于基线及治疗第4周时，采用弗雷克试验4.0、UCT、患者疾病严重程度总体评估（视觉模拟评分法，Patient’s Global Assessment of disease severity, PatGA-VAS）、医师疾病控制总体评估（视觉模拟评分法，Physician’s Global Assessment of disease control, PhyGA-VAS）及DLQI评估治疗应答情况。同时分析基线时TFS与UCT、DLQI、PatGA-VAS、PhyGA-VAS的相关性，以及治疗后（第4周）平均评分的变化情况。<b><i>结果：</i></b> 首次就诊时，患者的UCT平均得分为8.69±3.40，DLQI平均得分为7.88±6.02。第二次就诊时，TFS平均值从2.79±1.68降至1.91±1.85（<i>P</i> < 0.001），UCT评分与PhyGA-VAS均显著升高（<i>P</i> < 0.001），而DLQI评分、PatGA-VAS及瘙痒评分均显著降低（<i>P</i> = 0.002；<i>P</i> = 0.001；<i>P</i> = 0.012）。相关性分析显示，TFS与瘙痒评分（<i>r</i> = 0.378）、DLQI评分（<i>r</i> = 0.392）呈正相关；TFS与UCT评分（<i>r</i> = -0.283）及PhyGA-VAS（<i>r</i> = -0.347）呈负相关。<b><i>结论：</i></b> 本研究构建的全新弗雷克试验评分系统可与其他评估工具进行对比，且与多数评估工具存在中等程度相关性。建议采用疾病特异性评估工具，因其可对疾病严重程度、生活质量受损情况及疾病控制情况进行主观评估。