Challenging the Tools Used to Measure Cutaneous Lupus Severity in Patients of All Skin Types

Abstract

The development of tools that measure severity of inflammatory dermatologic diseases has lagged substantially behind those measuring disease extent in many fields of medicine. Over the years, severity scoring systems for acne, psoriasis, and atopic dermatitis have been developed as pharmaceutical trial requirements have been mandated by the US Food and Drug Administration (FDA). Cutaneous lupus erythematosus severity scoring was rudimentary until the development of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), a tool used to objectively measure the extent of skin involvement for patients with cutaneous lupus erythematosus (CLE). 1 The CLASI score consists of 2 parts: CLASI-A, which measures disease activity, and CLASI-D, which evaluates disease damage. Following the FDA's push for disease-specific global assessment scales, the Cutaneous Lupus Activity-Investigator Global Assessment (CLA-IGA) was developed. In this issue of JAMA Dermatology, Xie et al 2 evaluate how the erythema component of the CLASI-A scoring affects patient eligibility for cutaneous lupus trials.