Scoring systems for Oral Lichen Planus used by differently experienced raters

Area of Science:

• Oral Medicine
• Dermatology
• Clinical Trials

Background:

• Oral lichen planus (OLP) management relies on scoring systems to assess disease severity and activity.
• Existing systems require evaluation for their efficacy and correlation with patient-reported pain.

Purpose of the Study:

• To compare the reproducibility and clinical utility of two OLP scoring systems: the Reticular-erythematous-Ulcerative (REU) and a modified White-Erosive-Atrophic (WEA-MOD) system.
• To assess the correlation between these scoring systems and pain experienced by OLP patients.

Main Methods:

• Patients with OLP were assessed for pain using the Visual Analogue Scale (VAS) and intraoral examination at baseline (T0) and after three weeks of steroid therapy (T1).
• Photographs were evaluated by three raters using the REU and WEA-MOD scoring systems.
• Reproducibility was assessed using Kendall's W and interclass correlation coefficients; pain correlation was analyzed using Spearman's coefficient.

Main Results:

• The REU system demonstrated higher reproducibility (Kendall's W: 0.89 at T0, 0.83 at T1; ICC: 0.87-0.90) compared to WEA-MOD (Kendall's W: 0.74 at T0, 0.58 at T1; ICC: 0.58-0.87).
• Both REU and WEA scores significantly decreased post-therapy (p<0.000), aligning with VAS pain reduction (p<0.05).
• The REU score showed a significant correlation with VAS pain levels.

Conclusions:

• The REU scoring system offers superior reproducibility among raters for evaluating OLP severity.
• The WEA and WEA-MOD systems appear less reproducible in clinical practice.
• REU effectively correlates with OLP disease activity and associated pain, making it a valuable tool.