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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 2  |  Page : 188-190
Dermoscopy assisted topical steroid-dependent/damaged face (TSDF) severity score (DATS Score): Reliability assessment and validation of a new scoring method


1 From the Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Dermatology, Venereology and Leprosy, AIIMS, Bilaspur, Himachal Pradesh, India

Date of Web Publication13-Jul-2022

Correspondence Address:
Rashmi Jindal
From the Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_657_21

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How to cite this article:
Sethi S, Jindal R, Chauhan1 P. Dermoscopy assisted topical steroid-dependent/damaged face (TSDF) severity score (DATS Score): Reliability assessment and validation of a new scoring method. Indian J Dermatol 2022;67:188-90

How to cite this URL:
Sethi S, Jindal R, Chauhan1 P. Dermoscopy assisted topical steroid-dependent/damaged face (TSDF) severity score (DATS Score): Reliability assessment and validation of a new scoring method. Indian J Dermatol [serial online] 2022 [cited 2022 Aug 17];67:188-90. Available from: https://www.e-ijd.org/text.asp?2022/67/2/188/350805




Sir,

Topical steroid-dependent or damaged face (TSDF) shows an alarming prevalence of 90.5% in patients abusing topical corticosteroids (TCS).[1] They may produce a red face after a variable duration with unsupervised use, challenging to manage for both patients and dermatologists.[2] Dermoscopy can noninvasively help in identifying patients with TSDF before the appearance of clinical findings, especially when a history of such abuse is not forthcoming or the patient is unaware of it.[3] Erythema, dyspigmentation, papulopustular lesions, and hypertrichosis are common clinical signs in patients with TSDF.[4] Brown globules, red structureless areas, vessels, white hair, thick terminal hair, Demodex tails, papules/pustules, and white structureless areas are seen on dermoscopy.[5] However, there is no validated method to quantify the severity of damage due to TCS application. We propose a dermoscopy-assisted TSDF severity (DATS) score for estimating disease severity and response to treatment in TSDF.

DATS score includes assessment of facial areas involved and dermoscopic findings visualized. Concisely, the scoring system divides the face into four regions, and the disease severity is assessed by dermoscopy characteristics and the area of involvement, and a multiplication factor is used to calculate the total score [Table 1] and [Figure 1]. This study was undertaken to determine the reliability and validity of the DATS score. Three researchers (RJ, PC, and SS) independently rated 15 patients (14 women and one man) with TSDF on two consecutive days within one week to determine intra-rater and inter-rater reliability. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation, and striae) and with a history of application of TCS on the face for a period of more than 1 month were included. Validation was performed by comparing the DATS score with the physician global assessment (PGA) score (value ranging from 1 to 5, with 1 being least, 2 being mild, 3 being moderate, 4 being severe, and 5 being very severe disease). Content validity index for items (I-CVI) assessed in DATS score was constructed as a four-point ordinal scale; ratings of 1 and 2 were labeled nonrelevant, and 3 and 4 as relevant for each item in the questionnaire [Table 2]. Four consultants, two senior residents, and two final-year junior residents of our department completed I-CVI.
Figure 1: DATS score calculation in a representative patient. DATS score = [0.3 x (4+2+2+0) x 4] + [0.3 x (4+2+3+1) x4] + [0.3 x (4+2+3+1) x 4] + [0.1 x (0+0+0+0) x 0] = 33.6

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Table 1: Dermoscopy-assisted topical steroid-dependent/damaged face (TSDF) severity score (DATS score)

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Table 2: Content validity index for items (I-CVI)

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Test-retest reliability of individual raters tested by “Pearson's r” showed strong correlation for all three raters (r = 0.967, 0.991, and 0.984, respectively; P < 0.05). Inter-rater agreement computed by intra-class correlation coefficient showed substantial agreement (ICC = 0.6682; P < 0.05). Internal consistency measured by Cronbach's alpha was 0.856 (good internal consistency). Score fared well in content validity (I-CVI of 0.95) [Table 3]. Concurrent validity analysis was performed using Spearman's rank-order correlation between the DATS score and PGA scores of all three observers (RJ, PC, and SS) at both intervals [Table 3]. Scores were statistically significant across rater on both days (P < 0.001) with a very strong relationship. On usability assessment, the scale (1–5) had a mean of 4.8 ± 0.41 for RJ, 4.7 ± 0.52 for PC, and 4.3 ± 0.52 for SS.
Table 3: Results and interpretation of test-retest reliability, inter-rater agreement, internal consistency, concurrent validity, and usability assessment

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Thus, the DATS score appears to be a reliable and reproducible measure of TSDF severity. More extensive studies should be performed to identify the true potential of the DATS score in assessing the response to treatment. Dermoscopy decreases inter and intra-observer variation, resulting in a more objective score.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Saraswat A, Lahiri K, Chatterjee M, Barua S, Coondoo A, Mittal A, et al. Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients. Indian J Dermatol Venereol Leprol 2011;77:160-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Hameed AF. Steroid dermatitis resembling rosacea: A clinical evaluation of 75 patients. ISRN Dermatol 2013;2013:491376. doi: 10.1155/2013/491376.  Back to cited text no. 2
    
3.
Tatu AL. Topical steroid-induced facial rosaceiform dermatitis. Acta Endocrinol (Buchar) 2016;12:232-3.  Back to cited text no. 3
    
4.
Sonthalia S, Jha AK, Sharma R. The role of dermoscopy in a topical steroid-damaged face. Dermatol Pract Concept 2018;8:166-7.  Back to cited text no. 4
    
5.
Sethi S, Chauhan P, Jindal R, Bisht YS. Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study. Indian J Dermatol Venereol Leprol 2021. doi: 10.25259/IJDVL_11_2020.  Back to cited text no. 5
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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