Objective assessment of isotretinoin-associated cheilitis: Isotretinoin Cheilitis Grading Scale

Importance: 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. Design: Cross-sectional clinical grading study. Setting: UC Davis Dermatology clinic. Participants: Subjects were older than 18 years old and actively treated with oral isotretinoin. Exposures: Oral Isotretinoin. Main outcomes and measures: 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). Conclusion and relevance: 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.