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Scoring System in Dermatology: a Review

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Scoring System in Dermatology: a Review IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 7 Ver. IX (July. 2016), PP 89-99 www.iosrjournals.org Scoring System in Dermatology: A Review Dr. Ridhima Lakhani1 , Dr. Chaitra Prakash2 , Dr. Siddhi Tiwari3 ,Dr. Saroj Purohit4 , Dr. Vijay Paliwal5 , Dr. Deepak K. Mathur6 , Dr. Puneet Bhargava7 1,2,3,4,5,6,7Dept. Of Dermatology ,SMS Medical College , Jaipur(Raj) Abstract : In dermatology over years many scoring systems have been developed which help develop objectivity in clinical observation of various skin disorders . These scores use criteria which can be easily studied clinically and compared and are easily responsive to routine treatments . The scoring helps us in grading the severity of a particular disease , guiding therapy , also measuring the response of the treatment . Thus, these scoring systems help us predicting the prognosis of a particular disease . Keywords: Dermatology , scoring systems , prognosis. I. Introduction In dermatological practice, methods of evaluating the severity of skin diseases are often crude, subjective and not reproducible, which creates discrepancy in results and inter-individual variations. Hence, to maintain objectivity in observations, scores are used to evaluate the severity of skin diseases. This is particularly important for monitoring the response to therapy and for evaluating the efficacy of new drugs. Scores helps us in semiobjective assessment of skin diseases. Till better objective parameters are developed, scores will continue to remain the gold standard for assessing the severity of dermatological diseases in clinical research. Thus we have tried to compile the scoring systems used in all the major dermatological diseases. II. Methods and materials 10 year review articles from 2006 to 2016 appearing in various indices like Pubmed , Copernicus , Embase and Google scholar were reviewed for various scoring systems in dermatology . The following scoring systems were obtained1 : a. Atopic dermatitis: SCORAD & SASSAD b. Poriasis : PASI , SAPSI , SPI , E-PAP. c. Nail psoriais : NAPSI d. TEN : SCORTEN e. Vitiligo : VIDA & VASI f. Scleroderma : Hidebinding/Tethering skin score of Furst et al , Rodnan skin score , Kahaleh skin score g. Hirsutism : Ferriman & gallwey score h. Pemphigus vulgaris : PAAS ,ABSIS , PDAI i. Melasma : MASI j. Acne : shelley kligman , james tisserland , michealson , cooks grading k. Urticaria : UAS l. Alopecia areata : SALT score m. Dyshidrotic eczema : DASI n. Onychomycosis : OSI o. Lupus erythematosus : CLASI p. Sarcoidosis : CSAMI III. Review 1 Atopic Dermatitis : It is a chronic condition and is one of the four most common chronic inflammatory skin disorders. Measuring the severity of AD as objectively as possible is extremely important in clinical practice and for research purposes. The criteria of Hanifin and Rajka are regarded as classic, but are subject to criticism because of their complexity and unpractical aspects2 Scores that are commonly used for objective assessment of atopic dermatitis are 1. SCORing Atopic Dermatitis (SCORAD) DOI: 10.9790/0853-150798999 www.iosrjournals.org 89 | Page Scoring System In Dermatology: A Review 2. The Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score 1.1 Scorad (Scoring Atopic Dermatitis) : Developed by the European Task Force on atopic dermatitis in 1993, it is the most commonly used scoring system for measuring the severity of atopic dermatitis. It is used to standardize the assessment of atopic dermatitis and to help in the interpretation of therapeutic studies. The disadvantage of this scoring system is the significant interobserver variation which makes subsequent assessment of the patient by the same observer necessary The Scorad Index is a composite score based on 3 subscores: A The extent score based on body surface area calculated using the „Rule of 9‟. B Intensity score based on 6 clinical findings in atopic dermatitis, namely erythema, edema or papulations, oozing or crusting, excoriation, lichenification, dryness, graded on a scale of 0 – 3 (0- absent, 1- mild, 2- moderate, 3- severe). C The score for pruritus and sleep loss graded on a visual analog scale of 0 to 10. The severity is based on the average extent for the last 3 days or nights. Final formula for calculation of SCORAD is as follows: SCORAD = A/5 + 7(B/2) + C . 1.2 Sassad : The Six Area, Six Sign Atopic Dermatitis severity score has proved to be a simple and effective system for recording and monitoring disease activity in atopic dermatitis. The score is obtained by grading six signs- 1) erythema, 2) exudation, 3) excoriation, 4) dryness, 5) cracking and 6) lichenification, Each on a scale of 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), at each of six sites (arms, hands, legs, feet, head and neck, trunk). The maximum score is 108. 1.3 Other Scores For Atopic Dermatitis ADASI (Atopic dermatitis area severity Uses a three color-coding system of body charts and counting grid to measure index score) the number of points falling on the different areas . The Leicester score for atopic dermatitis Forerunner to the SASSAD . Involves assessing 10-body zones for erythema, disease activity excoriation, dryness, cracking, and lichenification, giving a maximum score of 150 Grading score of Rajka and Langeland Most suitable for baseline assessment rather than for monitoring severity for severity Simple scoring system for atopic dermatitis Scores 10 severity criteria (0-7) and 10 topographic sites (0-3) giving a of COSTA maximum OF 100. Basic clinical scoring system (BCSS) Simple score that assesses the presence or absence of disease in 5 body sites, giving a total score of 5. Atopic dermatitis severity index (ADSI) Assessment of erythema, pruritus, exudation, excoriation, and lichenification, each on a scale of 0 to 3 to give a maximum score of 15 Assessment measure for atopic dermatitis Most recently developed. Assessment of 6 body areas for scale and/or dryness, (ADAM) lichenification, erythema, and excoriations (0-3), and 4 further body areas for the presence or absence of eczema Eczema area severity index (EASI) Composite index that includes an assessment of erythema, infiltration and/or papulation, excoriation and lichenification, each on a scale of 0-3 2. Psoriasis : Psoriasis is a chronic inflammatory papulosquamous disorder characterized by erythematous plaques with superimposed silvery white adherent scales . PASI score is currently the gold standard score for the assessment of extensive psoriasis, but has the limitation of interobserver variation. Four sites of affection, the head (h), upper limb (u), trunk (t) and lower limbs (l), are separately scored. 1. Three parameters erythema, induration and desquamation, each of which is graded on a severity scale of 0 to 4, where DOI: 10.9790/0853-150798999 www.iosrjournals.org 90 | Page Scoring System In Dermatology: A Review • 0 = nil, • 1 = mild, • 2 = moderate, • 3 = severe and • 4 = very severe. 2. The area wise percentage involvement of the involved sites is calculated as: • 1 = less than 10% area; • 2 = 10- 29%; • 3 = 30-49%; • 4 = 50-69%; • 5 = 70-89%; and • 6 = more than 90%. The final formula for PASI score is: PASI = 0.1 (Eh + Ih + Dh) Ah + 0.2 (Eu + Iu + Du) Au + 0.3 (Et + It+ Dt) At + 0.4 (El + Il + Dl) Al The maximum score of PASI is 72. 3 Other Scores Used For Psoriasis Evaluation for prognosis with averaged New method for evaluating clinical symptoms of PASI (E-PAP) psoriasis during the observation period, by adding a parameter of time (the number of days of a disease) to PASI Salford psoriasis index (SPI) Measures the current extent, psychosocial disability and past severity of the disease . Self administered psoriasis area and Consists of a silhouette of a body for patients to severity index (SAPASI) shade in affected areas and of three modified visual analog scales for recording the redness, thickness, and scaliness of an average lesion 3. Nail Psoriasis : Scoring system for measuring nail psoriasis is “NAPSI” Nail plate is divided into quadrants by imaginary longitudinal and horizontal lines Nail plate changes Nail bed changes nail pitting, onycholysis, leukonychia, oil drop (salmon patch) red spots in the lunula, dyschromia, crumbling splinter hemorrhages hyperkeratosis score is 0 if the findings are not present, 1 if they are present in 1 quadrant of the nail, 2 if present in 2 quadrants of a nail, 3 if present in 3 quadrants of a nail, and 4 if present in 4 quadrants of a nail Thus each nail has a matrix score (0-4) and a nail bed score (0-4), and the total nail score is the sum of those 2 individual scores (0-8). Sum of the total score of all involved fingernails is the total NAPSI score for that patient at that time A modified version (mNAPSI) was developed to enhance the face validity and feasibility of this tool a more sensitive scale is needed here in the nail can be given a separate score for all 8 features in each quadrant. The resulting is a 0 to 32 scale . 2 DOI: 10.9790/0853-150798999 www.iosrjournals.org 91 | Page Scoring System In Dermatology: A Review 4. Toxic Epidermal Necrosis (Ten) Stevens-Johnson syndrome is an immune-complex–mediated hypersensitivity complex that typically involves the skin and the mucous membranes. The score commonly used for assessing the patients of TEN is SCORTEN. Scoring is based on the evaluation of seven independent risk factors within the first 24 hours of admission and on day 3 30 % The value of the total number of points determines the predicted mortality: POINTS MORTALITY 0-1 3.2% 2 12.1% 3 35.3% 4 58.3% >=5 90% 5. Vitiligo : Vitiligo is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. It presents with well-defined milky-white patches of skin. Vitiligo can be cosmetically very disabling, particularly in people with dark skin.
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