LAUSR

By this method, the maximum possible DPASI is 40. We have used this scoring system in our ADMH patients and have observed that higher scores correlate with poor prognosis (Fig. 1b–e). Another important factor to consider while treating these patients is the disease progression, as rapidly progressive disease often needs systemic treatment. The following factors were considered in the assessment of disease activity: (i) number of new lesions (ii) increase in size of existing lesion or new lesions in past 6 weeks. Stage 0: Non-progressive/stable disease, no new lesions and no increase in size of older lesions. Stage 1: Very slowly progressive disease, 1–5 new lesions with total increase in area <3 cm. Stage 2: Slowly progressive disease, 6–10 new lesions/total increase in area of ≥3 to <6 cm. Stage 3: Rapidly progressive disease, 11–15 new lesions/total increase in area ≥6 to <9 cm. Stage 4: Very rapidly progressive disease, >15 new lesions and increase in total area ≥9 cm. The major advantage of a quantitative scale is that they provide direct estimates of the expected quantitative responses that patients might expect to achieve. However, nominal and nonparametric methods can only estimate the proportion of patients who achieve a certain arbitrarily set level of response. Quantitative methods provide data that are both sensitive and meaningful to both patients and physicians. We expect this scoring system to markedly reduce interobserver variability as subjective evaluation of extent or severity by the observer is eliminated. Current lack of consensus on methods of assessment of this conundrum (akin to PASI in psoriasis) makes it principally impossible to evaluate the efficacy of new drugs or perform meta-analyses on the results of different studies of the same treatment. Ours is the first scoring method that has been proposed to surmount this problem and offer more accurate measures of disease severity indexes.