{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:47:46Z","timestamp":1787240866552,"version":"build-2736575974"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"\n Importance<\/jats:title>\n Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN.<\/jats:p>\n <\/jats:sec>\n \n Evidence Review<\/jats:title>\n A Delphi consensus using the RAND\/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles\/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.1347","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T11:33:02Z","timestamp":1685532782000},"page":"772","source":"Crossref","is-referenced-by-count":7,"title":["Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis"],"prefix":"10.1001","volume":"159","author":[{"given":"Margo","family":"Waters","sequence":"first","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Dobry","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie T.","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, Davis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanade","family":"Shinkai","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Beachkofsky","sequence":"additional","affiliation":[{"name":"Department of Dermatology, James A. 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P.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo R.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Kroshinsky","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Markova","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Micheletti","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Internal 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