Miloslavsky et al graded the severity of dermal toxicity associated with glucocorticoid therapy.
Patient selection: adverse skin effect associated with glucocorticoid therapy
Parameters:
(1) acneiform rash with papules and/or pustules
(2) easy bruising
(3) hirsutism in a female
(4) atrophy
(5) erosions, tears or ulcerations
|
Parameter |
Finding |
Severity |
|
acneiform rash |
Grade 1 or 2 (see below) |
mild |
|
|
Grade 3 (see below) |
moderate |
|
|
Grade 4 (see below) |
severe |
|
easy bruising |
Grade 1 (localized or in a dependent area) |
mild |
|
|
Grade 2 (generalized) |
moderate |
|
hirsutism |
Grade 1 (able to be camouflaged or removed by periodic intervention) |
mild |
|
|
Grade 2 (requires daily shaving or effort to hide; adverse psychological effect) |
moderate |
|
atrophy |
Grade 1 (< 10% BSA or telangiectasia or change in skin color) |
mild |
|
|
Grade 2 (10-30% BSA or striae or loss of adnexal structures) |
moderate |
|
|
Grade 3 (> 30% BSA or ulcerated) |
severe |
|
erosions/tears/ulcers |
Grade 1 (combined area < 1 cm or nonblanchable erythema of intact skin) |
mild |
|
|
Grade 2 (combined area 1-2 cm or partial thickness skin loss into subcutaneous tissue) |
moderate |
|
|
Grade 3 (combined area > 2 cm or full thickness skin loss down to fascia) |
severe |
where:
• Erosions/tears/ulcers have an area but units are in cm, not square cm.
Grades for Acneiform Rash
|
BSA Involved |
Disability |
Other |
Grade |
|
< 10% |
none |
none |
1 |
|
10-30% |
instrumental |
negative psychological |
2 |
|
> 30% |
self-care |
localized infection treated with oral antibiotics |
3 |
|
NA |
NA |
life-threatening complications; systemic infection requiring IV antibiotics |
4 |
Specialty: Endocrinology, Dermatology, Pharmacology, clinical
