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A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index
Author(s) -
Dirschka T.,
Pellacani G.,
Micali G.,
Malvehy J.,
Stratigos A.J.,
Casari A.,
Schmitz L.,
Gupta G.
Publication year - 2017
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.14267
Subject(s) - medicine , actinic keratosis , dermatology , forehead , scalp , chin , severity of illness , erythema , keratosis , surgery , basal cell , anatomy
Background Actinic keratosis ( AK ) severity is currently evaluated by subjective assessment of patients. Objectives To develop and perform an initial pilot validation of a new easy‐to‐use quantitative tool for assessing AK severity on the head. Methods The actinic keratosis area and severity index ( AKASI ) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index ( PASI ). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment ( PGA ) and AKASI . To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AK s was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. Results There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean ( SD ) AKASI increased from 2.88 (1.18) for ‘light’ to 5.33 (1.48) for ‘moderate’, 8.28 (1.89) for ‘severe’, and 8.73 (3.03) for ‘very severe’ PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. Conclusions Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.