Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;183(1):78-85.
doi: 10.1111/bjd.18566. Epub 2019 Nov 24.

Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid

M Ormond  1 , H McParland  1 , P Thakrar  2 , A N A Donaldson  3 , M Andiappan  3 , R J Cook  1   4 , M E Escudier  1   5 , J Higham  2 , E Hullah  1 , R McMillan  6 , J Taylor  7 , P J Shirlaw  1 , S J Challacombe  1   5 , J F Setterfield  1   5   8
Affiliations

Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid

M Ormond et al. Br J Dermatol. 2020 Jul.

Abstract

Background: Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit.

Objectives: The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA).

Methods: Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h.

Results: In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took < 5 s.

Conclusions: This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform. What's already known about this topic? There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP). Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP. What does this study add? The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP. Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies. What are the clinical implications of this work? We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.

PubMed Disclaimer

Similar articles

  • An Oral Disease Severity Score validated for use in oral pemphigus vulgaris.
    Ormond M, McParland H, Donaldson ANA, Andiappan M, Cook RJ, Escudier M, Hullah E, Higham J, McMillan R, Taylor J, Shirlaw PJ, Challacombe SJ, Setterfield JF. Ormond M, et al. Br J Dermatol. 2018 Oct;179(4):872-881. doi: 10.1111/bjd.16265. Epub 2018 Apr 28. Br J Dermatol. 2018. PMID: 29297927
  • ODSS vs. ABSIS and PDAI oral parts in pemphigus vulgaris: inter-rater reliability and testing times.
    Shamabadi A, Yazdinezhad S, Sadeghi Y, Moradi AR, Yazdchi A, Teymourpour A, Faramarzi A, Seirafi R, Balighi K, Mahmoudi H, Daneshpazhooh M. Shamabadi A, et al. Oral Dis. 2023 Oct;29(7):2696-2704. doi: 10.1111/odi.14320. Epub 2022 Jul 28. Oral Dis. 2023. PMID: 35852132
  • Pemphigus oral lesions area index (POLAI): A new scoring scale for assessing oral pemphigus vulgaris.
    Wang F, Zhang X, Yao Y, Wang J, Shi Y, Liu T, Xu H, Zhou Y, Dan H, Zeng X. Wang F, et al. Oral Dis. 2025 Jan;31(1):160-167. doi: 10.1111/odi.15054. Epub 2024 Jun 27. Oral Dis. 2025. PMID: 38937974
  • Large International Validation of ABSIS and PDAI Pemphigus Severity Scores.
    Hébert V, Boulard C, Houivet E, Duvert Lehembre S, Borradori L, Della Torre R, Feliciani C, Fania L, Zambruno G, Camaioni DB, Didona B, Marinovic B, Schmidt E, Schumacher N, Hünefeld C, Schanz S, Kern JS, Hofmann S, Bouyeure AC, Picard-Dahan C, Prost-Squarcioni C, Caux F, Alexandre M, Ingen-Housz-Oro S, Bagot M, Tancrede-Bohin E, Bouaziz JD, Franck N, Vabres P, Labeille B, Richard MA, Delaporte E, Dupuy A, D'Incan M, Quereux G, Skowro F, Paul C, Livideanu CB, Beylot-Barry M, Doutre MS, Avenel-Audran M, Bedane C, Bernard P, Machet L, Maillard H, Jullien D, Debarbieux S, Sassolas B, Misery L, Abasq C, Dereure O, Lagoutte P, Ferranti V, Werth VP, Murrell DF, Hertl M, Benichou J, Joly P; French Study Group on Autoimmune Bullous Skin Diseases; Autoimmune Bullous Skin Disease Task Force of the European Academy of Dermatology and Venereology. Hébert V, et al. J Invest Dermatol. 2019 Jan;139(1):31-37. doi: 10.1016/j.jid.2018.04.042. Epub 2018 Oct 6. J Invest Dermatol. 2019. PMID: 30301637 Review.
  • Immunodiagnosis of pemphigus and mucous membrane pemphigoid.
    Challacombe SJ, Setterfield J, Shirlaw P, Harman K, Scully C, Black MM. Challacombe SJ, et al. Acta Odontol Scand. 2001 Aug;59(4):226-34. doi: 10.1080/00016350152509256. Acta Odontol Scand. 2001. PMID: 11570526 Review.
See all similar articles

Cited by

References

    1. Setterfield J, Shirlaw PJ, Kerr-Muir M et al. Mucous membrane pemphigoid: a dual circulating antibody response with IgG and IgA signifies a more severe and persistent disease. Br J Dermatol 1998; 138:602-10.
    1. Ahmed AR, Kurgis BS, Rogers RS. Cicatricial pemphigoid. J Am Acad Dermatol 1991; 24:987-1001.
    1. Taylor J, McMillan R, Shephard M et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:161-71.
    1. Bastuji-Garin S, Sbidian E. How to validate outcome instruments for pemphigus. J Invest Dermatol 2009; 129:2328-30.
    1. Lee BWH, Tan JCK, Radjenovic M et al. A review of scoring systems for ocular involvement in chronic cutaneous bullous disease. Orphanet J Rare Dis 2018; 13:83.