title: Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional clinical grading study.
  
  
  METHODS
  UC Davis Dermatology clinic.
  
  
  METHODS
  Subjects were older than 18 years old and actively treated with oral isotretinoin.
  
  
  METHODS
  Oral Isotretinoin.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: a School of Medicine , UC Davis , Sacramento , CA , USA .
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ornelas
authors.affiliation: b Department of Dermatology , Geisinger Health System , State College , PA , USA .
authors.forename: Lorraine
authors.initials: L
authors.lastname: Rosamilia
authors.affiliation: c Department of Dermatology , UC Davis , Sacramento , CA , USA .
authors.forename: Larissa
authors.initials: L
authors.lastname: Larsen
authors.affiliation: c Department of Dermatology , UC Davis , Sacramento , CA , USA .
authors.forename: Negar
authors.initials: N
authors.lastname: Foolad
authors.affiliation: d Department of Statistics , UC Davis , Davis , CA , USA , and.
authors.forename: Quinlu
authors.initials: Q
authors.lastname: Wang
authors.affiliation: e Division of Biostatistics, Department of Public Health Sciences , UC Davis , Davis , CA , USA.
authors.forename: Chin-Shang
authors.initials: CS
authors.lastname: Li
authors.affiliation: c Department of Dermatology , UC Davis , Sacramento , CA , USA .
authors.forename: Raja K
authors.initials: RK
authors.lastname: Sivamani
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D002613:Cheilitis / Q000139:chemically induced*; D003430:Cross-Sectional Studies; D004890:Erythema / Q000139:chemically induced; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015474:Isotretinoin
keywords: Acne; cheilitis; isotretinoin; teledermatology