Derm Scores

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Indian Journal of Dermatology, Venereology and LeprologyMEDKNOW PUBLICATIONS ON BEHALF OF THE INDIAN ASSOCIATION OF DERMATOLOGISTS,VENEREOLOGISTS AND LEPROLOGISTS (IADVL)ISSN:0378-6323EISSN:0973-3922

VOL.72,NUM.4,2006, PP.315-321

Indian Journal of Dermatology, Venereology and Leprology, Vol. 72, No. 4, July-August, 2006, pp.315-321

Resident's Page

Scoring systems in dermatology

Bhor Urmila, Pande Sushil

Department of Dermatology, Seth GS Medical College and KEM Hospital, MumbaiCorrespondence Address:Department of Dermatology, Seth GS Medical College and KEMHospital, Mumbai, [email protected]

Code Number: dv06108

Dermatologists have the privilege of examining the largest organ of the body. However, unlike otherorgans, there are hardly any tests of clinical significance that measure skin function. Indermatological 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 skindiseases. This is particularly important for monitoring the response to therapy and for evaluating theefficacy of new drugs. Over the years scoring systems have been developed for a number of skin

diseases. This has greatly helped the cause of clinical practice and clinical research.

This article deals with scores that are commonly used and uniformly accepted for the ease ofassessment of common skin diseases.

ATOPIC DERMATITIS

Scores that are commonly used for objective assessment of atopic dermatitis are

1. SCORing Atopic Dermatitis (SCORAD)2. The Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score

SCORAD (SCORing Atopic Dermatitis)[1]Developed by the European Task Force on atopic dermatitis in 1993, it is the most commonly usedscoring system for measuring the severity of atopic dermatitis. It is used to standardize theassessment of atopic dermatitis and to help in the interpretation of therapeutic studies.

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
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predicted mortality: 0-1 points-3.2% mortality; 2 points-12.1%; 3-35.3%; 4-58.3%; 5-90%. [Table - 3]

VITILIGO

Two scores designed for the assessment of vitiligo are vitiligo area severity index (VASI)[15]andvitiligo disease activity score (VIDA).[16]

Vitiligo area severity indexThe percentage of vitiligo involvement is calculated in terms of hand units. One hand unit (whichencompasses the palm plus the volar surface of all digits) is approximately equivalent to 1% of thetotal body surface area. The degree of pigmentation is estimated to the nearest of one of thefollowing percentages: 100% - complete depigmentation, no pigment is present; 90% - specks ofpigment present; 75% - depigmented area exceeds the pigmented area; 50% - pigmented anddepigmented areas are equal; 25% - pigmented area exceeds depigmented area; and 10% - onlyspecks of depigmentation present.

The VASI for each body region is determined by the product of the area of vitiligo in hand units andthe extent of depigmentation within each hand unit measured patch.

Total body VASI = S All body sites [Hand Units] [Residual depigmentation]

Vitiligo disease activity score (VIDA)The VIDA is a six-point scale for assessing vitiligo activity. Scoring is based on the individual's ownopinion of the present disease activity over time. Active vitiligo involves either expansion of existinglesions or appearance of new lesions. Grading is as follows: VIDA Score +4 - Activity of 6 weeks orless duration; +3 - Activity of 6 weeks to 3 months; +2 - Activity of 3 - 6 months;+1 - Activity of 6 - 12months; 0 - Stable for 1 year or more; and -1 - Stable with spontaneous repigmentation since 1 yearor more. A low VIDA score indicates less activity.

SCLERODERMA

Scores used for scleroderma are summerized in [Table - 4].

HIRSUTISM

The Ferriman and Gallwey score[22]measures hirsutism in women by the degree of hair growth in11 body regions, out of which the forearm and hand, lower leg and feet are not included in the"hormonal" score. This is a time consuming and apparently complex semiquantitative scoringsystem for hirsutism. [Table - 5]

Even if hirsutism is present bilaterally on the extremities (upper arms, forearms, thighs and lowerlegs), only a single value is entered.

Ferriman Gallwey hormonal hair score = Sum of all scores.

The minimum score is zero and the maximum is 36. Obviously, the higher the score, the morehirsute is the woman. A score of less than 8 is considered as non hirsute, 8-16 as mild hirsutism, 17-25 as moderate hirsutism, and more than 25 as severe hirsutism. A score of more than 6 inCaucasian women indicates abnormal hair distribution. Each ethnic group may have a differentupper limit of the normal value.

PEMPHIGUS VULGARIS[23]
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area; right profile of scalp - 18% (0.18) of scalp surface area; left profile of scalp - 18% (0.18) ofscalp surface area; Posterior aspect of scalp - 24% (0.24) of scalp surface area. Percentage of hairloss in any of these areas is percentage hair loss multiplied by percent surface area of the scalp inthat area. SALT score is the sum of percentage of hair loss in all above mentioned areas. For e.g., ifthe percentage hair loss in vertex, right profile, left profile and posterior aspect is 20, 30, 40 and 50%respecively; then, SALT score = (20 0.4) = (30 0.18) + (40 0.18) + (50 0.24) = 8+5.4+7.2+12 =

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DYSHIDROTIC ECZEMA

Dyshidrotic eczema area and severity index (DASI) is proposed for dyshidrotic eczema.[31]

Dyshidrotic eczema area and severity index (DASI)Based on the severity grade of single items - number of vesicles per square centimetre (V),erythema (E), desquamation (S) and itch (I) - and the extension of the affected area (A) and iscalculated with defined score points (p) as: DASI = (pV + pE = pS + pI) pA.

DASI was found to be a simple and useful tool to assess the severity of dyshidrotic eczema and theeffect of therapy.

Thus application of mind helps to design scores for semi-objective assessment of skin diseases. Tillbetter objective parameters are developed, scores will continue to remain the gold standard forassessing the severity of dermatological diseases in clinical research.

References

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