Cutaneous Lupus Erythematosus: Disease Area and Severity Index reliability in clinical evaluation and assessment of cutaneous lupus erythematosus lesions in pediatric cases

Background: Children having systemic lupus erythematosus clinically reflect a management and diagnostic challenge. Cutaneous lupus erythematosus reflects the dermatological signs of SLE categorized into LE-specific and LE-nonspecific features. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Physician Global Assessment (PGA) are clinical tools categorizing the dermatological disease severity in cases having cutaneous lupus disease Aim of study: Assessment of CLASI scoring reliability and usefulness in pediatric cutaneous lupus. Methodology: A clinical research trial conducted on 100 research study subjects with pediatric cutaneous lupus erythematosus. Cases had an age range of 6–18 years. All research study subjects were assessed using both the CLASI and skin Physician’s Global Assessment clinical tools. Results: CLASI activity had excellent inter-rater and intra-rater reliability scores among dermatologists and rheumatologists (ICC = 0.965, 0.993, 0.924, 0.975 consecutively), CLASI damage had good interrater and intra rater scores among dermatologists (ICC = 0.810, 0.893 consecutively) on the other hand among rheumatologists it had poor interrater score (ICC =0.397) and good intra rater score (ICC =0.786). PGA activity had good inter rater reliability (ICC=0.830) and excellent intra rater variability (0.912) among dermatologists and among rheumatologists had fair inter rater and intra rater reliability (ICC=0.754, 0.784 consecutively) PGA damage had moderate inter rater reliability (ICC=0.593, 0.684) and fair intra rater reliability (ICC=0.783, 0.756) among dermatologists and rheumatologists consecutively.