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Waters, Margo; Dobry, Allison; Le, Stephanie T.; Shinkai, Kanade; Beachkofsky, Thomas M.; Davis, Mark D. P.; Dominguez, Arturo R.; Kroshinsky, Daniela; Markova, Alina; Micheletti, Robert G.; Mostaghimi, Arash; Pasieka, Helena B.; Rosenbach, Misha; Seminario-Vidal, Lucia; Trinidad, John; Albrecht, Joerg; Altman, Emily M.; Arakaki, Ryan; Ardern-Jones, Michael; Bridges, Alina G.; Cardones, Adela R.; Chadha, Angad A.; Chen, Jennifer K.; Chen, Steven T.; [...]

Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis : A Delphi Consensus Exercise : A Delphi Consensus Exercise

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  • Media type: E-Article
  • Title: Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis : A Delphi Consensus Exercise : A Delphi Consensus Exercise
  • Contributor: Waters, Margo; Dobry, Allison; Le, Stephanie T.; Shinkai, Kanade; Beachkofsky, Thomas M.; Davis, Mark D. P.; Dominguez, Arturo R.; Kroshinsky, Daniela; Markova, Alina; Micheletti, Robert G.; Mostaghimi, Arash; Pasieka, Helena B.; Rosenbach, Misha; Seminario-Vidal, Lucia; Trinidad, John; Albrecht, Joerg; Altman, Emily M.; Arakaki, Ryan; Ardern-Jones, Michael; Bridges, Alina G.; Cardones, Adela R.; Chadha, Angad A.; Chen, Jennifer K.; Chen, Steven T.; [...]
  • imprint: American Medical Association (AMA), 2023
  • Published in: JAMA Dermatology
  • Language: English
  • DOI: 10.1001/jamadermatol.2023.1347
  • ISSN: 2168-6068
  • Keywords: Dermatology
  • Origination:
  • Footnote:
  • Description: <jats:sec id="ab-dcs230002-1"><jats:title>Importance</jats:title><jats:p>Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent.</jats:p></jats:sec><jats:sec id="ab-dcs230002-2"><jats:title>Objectives</jats:title><jats:p>To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN.</jats:p></jats:sec><jats:sec id="ab-dcs230002-3"><jats:title>Evidence Review</jats:title><jats:p>A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement.</jats:p></jats:sec><jats:sec id="ab-dcs230002-4"><jats:title>Findings</jats:title><jats:p>In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated.</jats:p></jats:sec><jats:sec id="ab-dcs230002-5"><jats:title>Conclusions and Relevance</jats:title><jats:p>This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.</jats:p></jats:sec>