01SCORAD — Severity Scoring of Atopic Dermatitis
Score 0-103Atopic dermatitisStalder JF, 1993
Who it is for
- Atopic dermatitis (AD) at any age: infants, children and adults alike
- Tracking response before and after treatment (baseline / 4 weeks / 12 weeks)
- A reference point when applying for biologics such as dupilumab, JAK inhibitors, tralokinumab or lebrikizumab
Method — three components
SCORAD = A/5 + 7B/2 + C
- A · Affected area (0-100%), estimated by the rule of nines
- Head and neck 9% / each upper limb 9% (18% both) / front of trunk 18% / back of trunk 18% / each lower limb 18% (36% both) / perineum 1%
- Infants differ: head 18%, each lower limb 13.5%
- B · Six objective signs, total 0-18 (each 0-3)
- Erythema, oedema/papulation, oozing/crust, excoriation, lichenification, dryness (assessed on unaffected skin)
- 0 = none / 1 = mild / 2 = moderate / 3 = severe
- C · Subjective symptoms, total 0-20
- Pruritus 0-10 + sleep loss 0-10
- The average over the past 3 days, rated by the patient
How to read the score
What the result means, and what to do next
- SCORAD ≥ 50 is one of the reference thresholds for a Taiwan NHI dupilumab application (alongside EASI, DLQI and failure of topical therapy)
- Response: SCORAD-50 = a fall of ≥ 50% after treatment (clinically meaningful); SCORAD-75 = a good response
- Follow-up: moderate-to-severe disease should be reassessed every 4-12 weeks
- For infants, adjust per the Werfel 2024 S3 paediatric version — the area proportions differ
Limitations and cautions
Limitations: (1) the objective signs (B) need a dermatologist's assessment and are hard for a patient to rate accurately; (2) it is sensitive to fluctuation over the past 3 days; (3) it does not capture the functional impact of hand or genital involvement (use EASI or POEM instead); (4) erythema is easily overcalled in a crying infant.
Original citation
Open the SCORAD calculator →02PASI — Psoriasis Area and Severity Index
Score 0-72PsoriasisFredriksson, 1978
Who it is for
- Severity assessment for plaque psoriasis
- Taiwan NHI biologic threshold: PASI ≥ 10 + BSA ≥ 10% + DLQI ≥ 10, plus failure of two conventional therapies (methotrexate / phototherapy / acitretin)
- Not for: pustular, erythrodermic, guttate or scalp psoriasis (use PSSI for scalp)
Method
PASI = 0.1×(Eh+Ih+Dh)×Ah + 0.2×(Ea+Ia+Da)×Aa + 0.3×(Et+It+Dt)×At + 0.4×(El+Il+Dl)×Al
h = head and neck / a = upper limbs / t = trunk / l = lower limbs
- Four body regions, weighted: head and neck ×0.1, upper limbs ×0.2, trunk ×0.3, lower limbs ×0.4 (summing to 1.0)
- Three signs per region (0-4):
- E · erythema: none / light red / red / dark red / deep red
- I · induration (thickness): none / slight / moderate / thick / very thick
- D · desquamation: none / fine / coarse / thick / adherent
- Area grade (0-6): 0 = 0%, 1 = <10%, 2 = 10-29%, 3 = 30-49%, 4 = 50-69%, 5 = 70-89%, 6 = 90-100%
How to read the score
Response endpoints
- PASI 75: a fall of ≥ 75% after treatment (the conventional target)
- PASI 90: a fall of ≥ 90% (the routine target for IL-23-class biologics)
- PASI 100: complete clearance (bimekizumab reaches over 60% at 16 weeks)
What the result means, and what to do next
- PASI ≥ 10 + BSA ≥ 10% + DLQI ≥ 10 + two failed conventional therapies = eligible to apply for an NHI biologic
- Choose the biologic around the comorbidity: psoriatic arthritis → IL-17; inflammatory bowel disease → IL-23 or deucravacitinib
- For scalp psoriasis use PSSI (Psoriasis Scalp Severity Index) instead
Limitations and cautions
Limitations: (1) inter-observer variation is wide and training is needed; (2) it is insensitive in mild psoriasis (a 1-2 point change can accompany obvious clinical improvement); (3) it does not apply to pustular, erythrodermic or inverse forms; (4) severe but localised disease (hands, face) can give a low PASI — supplement with BSA and DLQI; (5) erythema is harder to grade in darker skin.
Original citation
Open the PASI calculator →03DLQI — Dermatology Life Quality Index
Score 0-30Any skin diseaseFinlay & Khan, 1994
Who it is for
- Any chronic skin disease from age 16 — psoriasis, atopic dermatitis, urticaria, prurigo nodularis, HS, vitiligo and others
- NHI biologic threshold: DLQI ≥ 10 for most conditions
- Tracking what treatment does to quality of life, not just to the appearance of the skin
- Children use CDLQI (Children's DLQI, ages 4-16); infants use IDQOL
Method
Ten self-rated items, 0-3 each, total 0-30. Each asks how much your skin affected that aspect of life over the past week.
Each item: 0 not at all / 1 a little / 2 a lot / 3 very much (score 0 if not relevant).
How to read the score
What the result means, and what to do next
- DLQI ≥ 10 means a very large or extremely large negative effect in most chronic skin disease
- An NHI biologic application usually needs two consecutive assessments both ≥ 10
- Note that an item marked "not relevant" (N/A) scores 0 — for instance Q9 on sexual difficulties for someone single — which can understate the true impact
- A sudden fall in score without objective improvement → assess for psychological adaptation or avoidance; a psychiatric comorbidity can mask the picture
Limitations and cautions
Limitations: (1) subjective, and sensitive to mood and cultural differences; (2) Q9 on sexual difficulties is commonly understated in Asia; (3) children and older people need the alternative versions; (4) it cannot replace objective disease assessment; (5) DLQI ≥ 10 alone does not support a biologic application — it must accompany a disease-activity scale (PASI, SCORAD, UAS7 and so on).
Original citation
Open the DLQI calculator →04SALT — Severity of Alopecia Tool
Score 0-100Alopecia areataOlsen EA, 2004
Who it is for
- Scalp hair-loss area in alopecia areata
- Establishing the indication for a JAK inhibitor (baricitinib, ritlecitinib)
- Tracking response (SALT-50, SALT-30, SALT-20)
- Not for: androgenetic alopecia (use Norwood-Ludwig), diffuse telogen effluvium, or cicatricial alopecia
Method — the scalp in four regions
SALT = (vertex % × 0.40) + (occiput % × 0.24) + (left side % × 0.18) + (right side % × 0.18)
- Vertex (40%): from the hairline to the crown
- Occiput (24%): the back of the head
- Left side (18%): above the left ear to the temple
- Right side (18%): above the right ear to the temple
- For each region estimate the percentage of that region that is bald (0-100%), in steps of about 5%
In practice: photograph the crown, nape and both sides in a mirror or with a phone, print or sketch the scalp outline, circle the bald areas and estimate the proportion on squared paper. A family member helping makes it more accurate.
How to read the score
Special forms: alopecia totalis (whole scalp) = SALT 100%; alopecia universalis (whole body) = SALT 100% plus all body hair
Response endpoints
- SALT-30 / 50 / 75 / 90: the percentage fall in SALT after treatment
- BRAVE-AA (baricitinib) 4 mg: 38.8% reached SALT ≤ 20 at 36 weeks, against 6.2% on placebo
- ALLEGRO (ritlecitinib) 50 mg: 23% reached SALT ≤ 20 at 24 weeks, against 2%
What the result means, and what to do next
- SALT ≥ 50 is the approved indication for a JAK inhibitor — but the EMA warned in 2023 that people aged 65+, or at high cardiovascular, malignancy or VTE risk, should receive one only where no alternative exists
- Screen before starting: tuberculosis, hepatitis B and C, HIV, full blood count, liver and renal function, lipids, CPK, and any history of malignancy
- A family history, childhood onset or coexisting atopic dermatitis all carry a poorer prognosis
- Follow-up: assess response at 12, 24 and 36 weeks after starting
Limitations and cautions
Limitations: (1) estimation error is large, especially in the 30-70% range; (2) it does not assess eyebrows, eyelashes or body hair (the EBA / ELA scales used in ALLEGRO cover those); (3) it is highly subjective, with wide inter-observer variation; (4) the AAS (Alopecia Areata Scale, King 2022) is a newer alternative that includes brows and lashes.
Original citation
Open the SALT calculator →05UAS7 — Urticaria Activity Score over 7 days
Score 0-42Chronic spontaneous urticaria (CSU)EAACI 2018
Who it is for
- Daily activity tracking in chronic spontaneous urticaria (CSU); it must be recorded on seven consecutive days
- Establishing the indication for omalizumab under the NHI PASS assessment
- Not for: acute urticaria (< 6 weeks), inducible urticaria (use a trigger threshold test), or angioedema
Method — a diary over seven consecutive days
UAS7 = Σ (wheal count + itch) from day 1 to day 7
Up to 6 points a day (wheals 0-3 + itch 0-3), so at most 42 over seven days. The free EAACI urticaria diary app pairs well with it.
How to read the score
What the result means, and what to do next
- The treatment target is UAS7 ≤ 6 (well controlled); UAS7 = 0 is the ideal
- UAS7 and the UCT (Urticaria Control Test, 4 items) complement each other: the UCT is easier to remember, UAS7 is more precise
- Around 30% of CSU patients respond inadequately to omalizumab, particularly the type IIb autoimmune group with low IgE and high anti-TPO IgG
- On the horizon: remibrutinib (BTK) and dupilumab (FDA-approved 2024) as alternatives after omalizumab failure
Limitations and cautions
Limitations: (1) it needs seven consecutive days of recording, and adherence is often poor; (2) it does not cover angioedema (use AAS / AAS7); (3) it does not apply to inducible urticaria; (4) self-rating tends to under- or over-state; (5) UAS7 = 0 with continuing distress → assess for anxiety, which coexists with depression or anxiety in 7-29% of CSU.
Original citation
Open the UAS7 calculator →06GAGS — Global Acne Grading System
Score 0-44Acne vulgarisDoshi-Zaheer-Stiller, 1997
Who it is for
- Severity assessment for any acne, in adolescents and adults alike
- Establishing the NHI indication for oral isotretinoin
- Tracking response to treatment
Method
GAGS = Σ (grade of the most severe lesion at a site × the site's weight)
Grade the most severe lesion at each site:
- 0 = no lesions
- 1 = ≥1 comedone
- 2 = ≥1 papule
- 3 = ≥1 pustule
- 4 = ≥1 nodule or cyst
How to read the score
What the result means, and what to do next
- GAGS does not assess scarring, post-inflammatory marks or psychological impact — pair it with ECCA (scarring) and DLQI (psychological)
- A woman with premenstrual flares, jawline or neck distribution, hirsutism and irregular periods → consider endocrine assessment for PCOS
- New-onset acne in a woman over 30 → exclude polycystic ovary syndrome, an androgen-secreting tumour and menstrual irregularity
- Before oral isotretinoin: liver function, lipids, and a pregnancy test — with strict contraception for anyone of childbearing potential
Limitations and cautions
Limitations: (1) it does not assess scarring (use ECCA or the Goodman scar scale); (2) it does not assess post-inflammatory erythema or hyperpigmentation, which matter in Asian skin; (3) grading by the most severe lesion can overstate — a single nodule scores 4; (4) the IGA (Investigator's Global Assessment, 0-4) is simpler; (5) the six-grade IAA-GES has become common in recent FDA trials.
Original citation
Open the GAGS calculator →07MASI — Melasma Area & Severity Index
Score 0-48MelasmaKimbrough-Green, 1994
Who it is for
- Severity and treatment response in melasma
- Not for: solar lentigines, naevus of Ota or Hori's naevus (use OMRA / ABRA), or post-inflammatory hyperpigmentation (use PGA)
- The simplified mMASI (modified MASI), which drops the homogeneity item, is now widely used
Method
MASI = 0.3×Af×(Df+Hf) + 0.3×Ar×(Dr+Hr) + 0.3×Al×(Dl+Hl) + 0.1×Ac×(Dc+Hc)
f = forehead / r = right cheek / l = left cheek / c = chin
- Four facial regions, weighted: forehead ×0.3, right cheek ×0.3, left cheek ×0.3, chin ×0.1
- Area A (0-6): the same grades as PASI (0 = 0%, 1 = <10%, 2 = 10-29% … 6 = 90-100%)
- Darkness D (0-4): 0 = absent / 1 = slight / 2 = moderate / 3 = marked / 4 = severe
- Homogeneity H (0-4): how uniform the colour is within the patch, 0 = minimal / 4 = completely uniform
How to read the score
Response endpoints
- MASI-50: a fall of ≥ 50% after treatment (clinically meaningful)
- A typical course takes 8-16 weeks before the change is obvious
What the result means, and what to do next
- Melasma cannot be cured, only controlled — it darkens again once treatment stops, and photoprotection is lifelong
- Oral tranexamic acid is contraindicated with a history of deep vein thrombosis, in pregnancy, and with the combined oral contraceptive pill (thrombotic risk)
- Conventional high-fluence lasers can drive melasma darker — use low-fluence toning (picosecond) instead
- In pregnancy and breastfeeding: photoprotection plus azelaic acid (L3, safe); avoid hydroquinone, tranexamic acid and the triple combination cream
Limitations and cautions
Limitations: (1) subjective, with wide inter-observer variation; (2) homogeneity (H) is hard to judge in the deep brown melasma common in Asian skin; (3) it does not distinguish dermal from epidermal melasma (a Wood's lamp helps); (4) before-and-after photographs must use fixed lighting, distance and angle; (5) mMASI, without H, has better inter-observer reliability.
Original citation
Open the MASI calculator →08Hurley staging — Hidradenitis Suppurativa Staging
Stage I-IIIHidradenitis suppurativa (HS)Hurley HJ, 1989
Who it is for
- Severity staging for hidradenitis suppurativa (HS, acne inversa)
- Establishing the indication for conditionally NHI-funded adalimumab (Hurley II/III)
- Not for: a simple furuncle, acute folliculitis, or pilonidal sinus
Method — three stages
How to read it, and the treatment it points to
Supporting scales
- Sartorius score: a finer counting system (lesion count × anatomical site × distance)
- IHS4 (International HS Severity Score System): nodules + abscesses ×2 + tracts ×4, used to track trial response
- HiSCR (HS Clinical Response): a fall of ≥ 50% in abscess and nodule count with no increase in tracts counts as a response — the adalimumab trial endpoint
What the result means, and what to do next
- HS is diagnosed an average of 7-10 years late, often mistaken for boils or folliculitis; intervening early avoids irreversible tract formation
- Hurley II/III + DLQI ≥ 10 + failure of two conventional therapies = the NHI threshold for adalimumab
- Comorbidity is common — Crohn's disease, psoriatic arthritis, pyoderma gangrenosum, metabolic syndrome, depression — and should be screened for systematically
- Stopping smoking, losing weight and treating consistently are what determine the long-term result
Limitations and cautions
Limitations: (1) three stages are too coarse, and stage II covers a very wide range; (2) it says nothing about current activity — someone can be stage III with no new lesions; (3) it is unsuited to tracking response (use IHS4 or HiSCR); (4) it is subjective, and telling a tract from a scar takes experience.
Original citation
View Hurley staging →09Norwood-Hamilton / Ludwig — clinical grading of androgenetic alopecia
Men I-VII / women I-IIIAndrogenetic alopecia (AGA)Norwood 1975 · Ludwig 1977
Who it is for
- Male pattern hair loss → use Norwood-Hamilton (I-VII)
- Female pattern hair loss → use Ludwig (I-III), or Olsen for the central pattern
- Not for: alopecia areata (use SALT), diffuse telogen effluvium (use a pull test with trichoscopy), or cicatricial alopecia
Norwood-Hamilton grades (men)
Ludwig grades (women)
The female pattern: the Christmas tree sign — the central parting widens into a triangle while the frontal hairline is preserved, unlike the male pattern.
Treatment strategy it points to
What the result means, and what to do next
- Minoxidil cannot be stopped — the benefit is lost 3-6 months after stopping, and within two years the loss returns to where it would have been
- Finasteride side effects: reduced libido or erectile difficulty in about 1-2%, reversible on stopping; post-finasteride syndrome is very rare
- Finasteride and dutasteride are contraindicated in women because of teratogenicity, even before a pregnancy
- Take finasteride for six months before transplantation to stabilise the loss, so the untransplanted areas do not continue receding two to five years later
Limitations and cautions
Limitations: (1) inter-observer variation is wide for early Norwood grades (I-II); (2) Ludwig does not suit women with frontal recession (use Olsen's central pattern grading); (3) it does not measure shaft miniaturisation, which trichoscopy detects far earlier; (4) some female pattern loss coexists with androgen excess — check testosterone, DHEAS and screen for PCOS.
Original citation
Open the Norwood-Ludwig grading tool →10Fitzpatrick skin phototype — a reference for photoprotection and laser safety
Type I-VIAll of dermatology and aestheticsFitzpatrick TB, 1975
Who it is for
- Pre-procedure assessment for any laser, chemical peel or aesthetic treatment, predicting the risk of post-inflammatory hyperpigmentation
- Stratifying photoprotection needs and skin cancer risk
- It does not simply mean skin colour — it reflects how skin reacts to sun exposure, i.e. photosensitivity
Method — two dimensions
Combines your unexposed baseline skin colour with how it reacts after 30-60 minutes of early-summer midday sun.
What each type means in practice
What the result means, and what to do next
- Most Taiwanese are type III-IV — the risk of darkening after a laser or peel is high, so photoprotect strictly for at least four weeks
- Types I-II should have a full skin examination annually, particularly over the age of 50
- Skin cancer risk is low in types V-VI, but SCC often arises on the sole or under a nail and is easily missed, since pigment obscures it
- Sunscreen containing iron oxide matters particularly for Asian types III-VI, because it blocks the visible light that drives melasma
Limitations and cautions
Limitations: (1) it relies on self-report, with its own biases; (2) the same person answers differently in winter and summer; (3) it does not directly measure melanin — a Mexameter or spectrophotometer does; (4) the international classification does not fit Asian populations well, and the ITA (Individual Typology Angle) is finer; (5) phototype is not an absolute cancer risk — genetics, cumulative UV exposure and family history matter more.
Original citation
Open the Fitzpatrick typing tool →How to use these — a scale is a tool, not a diagnosis
- A scale makes something subjective measurable, so you can describe how your disease has changed precisely rather than as a vague "a bit better than last time".
- The trend matters more than the number: a single score means little, and only 4-12 weeks of consecutive readings show a direction. Photographs and a diary help.
- Use more than one: disease activity (SCORAD / PASI) + quality of life (DLQI) + psychological comorbidity (PHQ-9 / GAD-7) together give the full picture.
- An NHI biologic application requires a specialist's own assessment and signature; a self-rated score is for reference only and cannot be submitted on its own.
- None of the scales on this site carries advertising, sponsorship or affiliate links, and every society consensus cited can be checked on PubMed. If you spot an error, please email us.
Further reading: for the full patient guides see the
article index; for plain-English explanations of the terminology see the
dermatology glossary. For assessment, prescribing and treatment itself, please see a dermatologist in person.
