The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable and valid outcome instrument for pediatric cutaneous lupus erythematosus (CLE), with CLASI activity measurement demonstrating excellent inter-rater and intra-rater reliability, and superiority to findings with the Physician Global Assessment (PGA), according to data published in the British Journal of Dermatology.

A total of 11 patients with pediatric CLE were enrolled in the study. Physicians were trained to use the CLASI and the PGA, individually rating all patients with the use of both tools. Within each group of physicians, the Intraclass Correlation Coefficient (ICC) was calculated in order to evaluate the reliability of the 2 measures.

Of the 11 participants with pediatric SLE, 4 had discoid lupus erythematosus, 4 had acute CLE, 2 had tumid lupus erythematosus, and 1 had subacute CLE. Of the 55 categories that receive a score in the CLASI — 29 categories are considered “activity” and 26 are considered “damage” — all were reported in the current patient population (ie, they received a score of ≥1), except for the damage score of “scarring/atrophy/panniculitis” of the abdomen.

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The CLASI activity scores demonstrated excellent interrater and intrarater reliability (ICC >0.90), whereas the PGA activity scores demonstrated good interrater reliability (ICC=0.73 to 0.77) in both dermatology and rheumatology. Moreover, the PGA activity scores demonstrated excellent intrarater reliability (ICC=0.89) and good intrarater reliability (ICC=0.76) among dermatologists and rheumatologists, respectively.

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The investigators noted that the main limitations of the study included its small sample size and the potential recall bias during the physicians’ re-rating session.

A majority of the physician participants reported that the CLASI was an easier tool to use compared with the PGA. Thus, the CLASI could be used in future trials of pediatric patients with CLE.


Kushner CJ, Tarazi M, Gaffney RG, et al. Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in pediatric cutaneous lupus among pediatric dermatologists and rheumatologists [published online
July 23, 2018]. Br J Dermatol. doi:10.1111/bjd.17012