Cutaneous Sarcoidosis Outcome Instruments: Reliability and Validity Among Dermatologists, Pulmonologists, and Rheumatologists

Valid and reliable cutaneous sarcoidosis outcome instruments are required for the rigorous clinical research that will lead to evidence-based treatments for cutaneous sarcoidosis. Cutaneous sarcoidosis outcome instruments may provide an accessible, low-cost, low-risk tool to measure disease activity and should be accessible and comprehensible to non-dermatologist investigators. The sarcoidosis activity and severity index (SASI) and the cutaneous sarcoidosis activity and morphology instrument (CSAMI) both demonstrate validity and reliability among dermatologists and non-dermatologists alike. The CSAMI correlates strongly with patient-reported quality of life (QOL) metrics, as well as histologic measures of disease activity. The SASI is a simpler tool initially developed for the assessment of facial sarcoidosis, which has been successfully utilized as an outcome instrument in clinical trials. Both of these instruments demonstrated markedly decreased reliability when tested using store-and-forward teledermatology technology. High-frequency ultrasonography (HFU) is an emerging technology that could provide a valid, reliable, and objective measure of cutaneous sarcoidosis activity. Further research is needed to establish standardized imaging protocols and confirm the results of existing studies.