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Abstract
Importance: Isotretinoin remains an effective treatment for severe acne. Despite its effectiveness, it includes many side effects, of which cheilitis is the most common. Objective: To develop an objective grading scale for assessment of isotretinoin-associated cheilitis. Design: Cross-sectional clinical grading study. Setting: UC Davis Dermatology clinic. Participants: Subjects were older than 18 years old and actively treated with oral isotretinoin. Exposures: Oral Isotretinoin. Main outcomes and measures: We developed an Isotretinoin Cheilitis Grading Scale (ICGS) incorporating the following four characteristics: erythema, scale/crust, fissures and inflammation of the commissures. Three board-certified dermatologists independently graded photographs of the subjects. Results: The Kendall’s coefficient of concordance (KCC) for the ICGS was 0.88 (p < 0.0001). The Kendall’s coefficient was ≥0.72 (p < 0.0001) for each of the four characteristics included in the grading scale. An image-based measurement for lip roughness statistically significantly correlated with the lip scale/crusting assessment (r = 0.52, p < 0.05). Conclusion and relevance: The ICGS is reproducible and relatively simple to use. It can be incorporated as an objective tool to aid in the assessment of isotretinoin associated cheilitis.
Acknowledgements
We thank Ashutosh Chhibbar and Shefali Sharma from Brigh-Tex BioPhotonics for their technical support in assisting in the image analyses.
Declaration of interest
The authors have no conflict of interest to declare. The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through grant #UL1 TR000002.