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

Area of Science:

• Dermatology
• Clinical Informatics
• Patient Safety

Background:

• Current scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) primarily focus on prognosis, comorbidities, and systemic features.
• Inconsistent morphologic terminology for EN lesions hinders standardized assessment and research.
• There is a need for a skin-directed scoring system to complement existing prognostic tools.

Purpose of the Study:

• To achieve expert consensus on standardized terminology for EN lesions.
• To define the morphologic progression and most-affected sites of EN.
• To develop a framework for a novel, skin-directed scoring system for EN.

Main Methods:

• A Delphi consensus process utilizing RAND/UCLA appropriateness criteria was employed.
• A core group of 54 dermatology hospitalists participated in two rounds of consensus-building.
• Agreement was sought on terminology, morphologic traits, and sites of EN involvement.

Main Results:

• Consensus was reached on the need for a skin-specific EN instrument.
• The most frequently affected sites were identified as head and neck, chest, upper back, ocular mucosa, and oral mucosa.
• Key morphologic traits, including blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions, were consistently defined.

Conclusions:

• This consensus exercise confirms the necessity for a standardized, skin-directed scoring system for EN.
• Established nomenclature and defined morphologic traits provide a foundation for consistent EN assessment.
• The findings facilitate the development of a reliable instrument for evaluating EN severity and characteristics.