A challenging problem in comparing the results for skin toxicity is the difference in the scoring system between the research groups. On the following page, we will report the different grading systems adopted by the different groups and propose a new “uniform” classification method.
Light skin toxicities are shown in yellow, moist desquamation-related toxicities are shown in orange, and severe skin toxicities are shown in red. Moist desquamation, and the percentage of skin experiencing it, is the easiest toxicity to score because it can be recognised; on the contrary, light skin toxicities are not easy to differentiate. Moreover, severe skin toxicities are usually not allowed because of ethical reasons. Because of these considerations, moist desquamation is and should be the typical endpoint analysed.
| Sørensen et al. | Mascia et al. and Cunningham et al. | Iturri et al. | Bewley et al. | Soto et al. | Tavakkoli et al. | Duval et al. | Konradsson et al. | Rudigkeit et al. |
|---|---|---|---|---|---|---|---|---|
| 0.5 - Normal | 0 - Normal | 1 - Definite reddening | 1 - <50% depigmentation | 0 - normal | 0 - Pre-treatment, normal | 1 - normal | 0 - no | |
| 1 - Abnormality with reddening | 1 - Normal | 1 - dull, faint erythema with epilation | 1.5 - very slight breakdown of the skin surface | 2 - 50% depigmentation | 1 - ulceration | 1 - Dry /pre-moist desquamation | 2 - hairloss | 1 - dry |
| 1.5 - Moist desquamation of one small area | 2 - Alopecia | 2 - bright erythema with dry desquamation | 2 - Breakdown of a large area and/or toes stuck together, possibly moist in places | 3 - 50% alopecia (depigmentation) | 2/3 - Partial/full thickness epidermal lysis (ulceration)/desquamation with moisture | 3 - erythema | 2 - crust formation | |
| 2.0 - Moist desquamation of 25% of skin area | 3 - Erythema | 2.5 - Patchy moist desquamation with moderate erythema | 2.5 - About one-half of the foot broken down | 4 - >50% alopecia (depigmentation) | 4 - dry desquamation | 3 - moist | ||
| 2.5 - Moist desquamation of 50% of skin area | 4- Dry desquamation | 3 - Confluent moist desquamation with pitting erythema | 3 - Almost complete breakdown of the foot | 5 - <50% ulceration (alopecia and depigmentation) | 5 - <30% moist desquamation | |||
| 3.0 - Moist desquamation of 75% of skin area | 5 - Moist desquamation of 30% of the skin | 4 - Spontaneous bleeding | 6 - >50% ulceration (alopecia and depigmentation) | 6 - >30% moist desquamation | ||||
| 3.5 - Moist desquamation of the entire area | 6 - Moist desquamation of 70% of the skin | 4.5 - ulceration | ||||||
| 5 - necrosis |