Development and Initial Validation of a Novel System to Assess Ichthyosis Severity

Qisi Sun, Sarah Asch, Cheryl Bayart, Susan J. Bayliss, Latanya Benjamin, Anna Bruckner, John J. Digiovanna, Philip Fleckman, Tracy Funk, Anne Lucky, Caroline A. Nelson, Brandon Newell, Ingrid Polcari, Joyce Teng, Mary L. Williams, Geliang Gan, Yanhong Deng, Amy S. Paller, Keith A. Choate

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Importance: A comprehensive, user-friendly system to assess global ichthyosis disease burden is imperative to improving the care of patients with ichthyosis, identifying appropriate participants for clinical trials, and quantifying treatment outcomes. To our knowledge, there is currently no validated scale to objectively and systematically measure ichthyosis severity across the entire body. Objective: To create and evaluate a comprehensive and user-friendly instrument to measure total body ichthyosis severity in adults and children. Design, Setting, Participants: In this qualitative study, ichthyosis experts participated in the content development of the Ichthyosis Scoring System (ISS). The body was divided into 10 regions, and Likert scales (0-4) were created to quantify scale and erythema, with extensive descriptors and photographic standards. An 83-image teaching set was created from photographs of participants with ichthyosis. Two cohorts of dermatologists (11 total) independently scored all test photographs twice to evaluate interrater and intrarater reliabilities. Participants were enrolled worldwide from referral centers and patient advocacy groups. Participants of all ages, races, and ethnicities were included in the creation of ISS, and dermatologists with varying experience and areas of expertise participated as raters to evaluate the ISS. The study was conducted from 2019 to 2021, and the data were analyzed in 2021. Main Outcomes and Measures: Intraclass correlation coefficients determined overall reliabilities. Results: Across both cohorts of 11 dermatologists in total, the intraclass correlation coefficients for total, scale and erythema scores were greater than 0.90 (95% CI, 0.77-0.97), greater than 0.91 (95% CI, 0.79-0.98), and greater than 0.88 (95% CI, 0.72-0.97), respectively. Most body sites exhibited moderate to good interrater reliabilities for scale and erythema. Intrarater reliabilities were good to excellent. Conclusions and Relevance: The results of this qualitative study demonstrate reproducibility and suggest that the ISS is a reliable system to measure global ichthyosis severity in adults and children.

Original languageEnglish
Pages (from-to)359-365
Number of pages7
JournalJAMA Dermatology
Issue number4
StatePublished - Apr 2022


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