SCOREPI¹, a tool to aid in the clinical evaluation of irritative dermatitis

Irritative dermatitis is a common dermatosis caused by diverse physical and chemical substances which irritate the skin on contact, often with immediate effect.² It is a highly heterogeneous category as it ranges from the dermatitis known as nappy rash to acid burns.

Irritative dermatitis is most commonly attributed to chemicals, especially those used in the workplace e.g. detergents, soaps, creams and hair dyes.^2,3

However, it can also be caused by overexposure to water due to repeated hand washing and is therefore common amongst medical professionals.³
Additionally, other environmental factors can play a role such as extended exposure to cold temperatures, sun or wind. Repeated mechanical force has also been reported to lead to irritative dermatitis.⁴

The most commonly affected sites are exposed areas such as hands and face, with hand involvement in approximately 80% of patients and face involvement in 10%.⁵

Irritative dermatitis is a non-allergic response to direct skin damage that releases mediators of inflammation predominantly from epidermal cells. It may be acute or chronic.
In the acute phase, it manifests itself by redness, erythema, mild oedema and scaling but, with chronicity, appears lichenification, hyperkeratotic scale, fissures, or ulcerations. If left untreated, the disease can lead to complications such as loss of tactile sense, loss of mobility and secondary fungal infections.^3,5

Although common, irritative dermatitis has been poorly studied and up until now there was no tool existing to help clinical evaluation.
In order to overcome this problem, a group of French dermatologists developed the SCOre de REparation de l’EPIderme (SCOREPI).¹

What is SCOREPI?

SCOREPI is a clinical evaluation aid designed for use in everyday practice. SCOREPI is easy to learn in a very short time (15 min) and can be completed very quickly. Only four clinical elements are required:

• Lesion surface: If the lesion is smaller than the palm surface (score 1 to 4): 1 point for each quarter of a palm. If the lesion is larger than the palm surface (score 5 to 10): 1 point for each palm up to 8 (for scores of 9 and above, a different diagnosis should be considered).
• Erythema: 2 points if present, 0 if not. NB Severity not noted.
• Desquamation: 2 points if present, 0 if not. NB Severity not noted.
• Cracked skin: is judged as either i) superficial (crackled appearance) or erosive appearance (particularly on the lips) or ii) deep cracks affecting deep dermis (such as cracks in the heels or fingertips) which receive higher scores.

After adding the scores for each element, the total result is between 0 and 39. At any moment during therapy, only few seconds are needed to calculate a SCOREPI that can help assessing the disease severity and evolution for any patient of any age.¹

Validation of SCOREPI in irritative dermatitis¹

Two studies were conducted to validate SCOREPI.

1. Cross-sectional study: assessment of intra- and inter-observer error associated with using SCOREPI. Each investigator received 15 min of training on the correct use of SCOREPI. A computer displayed a series of 20 photos of irritative dermatitis, each of which were repeated three times in a randomized manner.
2. Prospective study: correlation of SCOREPI with the severity of clinical symptoms as well as the sensitivity of the score to changes in irritative dermatitis in response to a topical treatment which soothes irritation and redness.

Design: 49 patients (15 to 77 years) were assessed at D0 and D30.
Assessment : SCOREPI and rating of each functional sign intensity (tightness, pins and needles, burning, pruritus).
Treatment : healing and soothing topical preparation.

The scores were remarkably stable over multiple viewings of the same photo by a single observer, demonstrating excellent intra-observer reproducibility (intra-class correlation coefficient = 0.93). The intra-class correlation coefficient (0.74) demonstrated moderate inter-observer reproducibility for the overall SCOREPI score. Differences in scoring of the same photo by different physicians came from the estimation of the surface (P = 0.04), the presence or absence of erythema (P < 0.0001) and the number of deep cracks (P = 0.0008).
At baseline, the mean ± SD SCOREPI was 10.45 ± 4.61 (median 10). No patient reached the theoretical minimum or maximum on the SCOREPI at the baseline visit (0 and 39, respectively). Indeed, the lowest and highest scores recorded at baseline were 3 and 22, respectively.

As shown in Table 3, the decrease of SCOREPI was more pronounced in patients experiencing improvement, meaning those who healed well or very well (p = 0.0004). In the entire sample, the SCOREPI decreased considerably during follow-up from 10.45 ± 4.61 to 4.82 ± 4.15 (P < 0.0001). Subjective signs of tightness, pain and burning also decreased significantly during this period (P < 0.0001 for all). After adjusting for the baseline score, the mean SCOREPI change during follow-up was -0.36 for patients who healed poorly, -3.12 for those who healed moderately, -3.74 for those who healed well, and -8.64 in patients who healed very well. Finally, the Cohen score rating of SCOREPI’s sensitivity to track change in disease severity was 1.18, indicative of very high sensitivity.