ABSIS — Autoimmune Bullous Skin Disorder Intensity Score

Autoimmune Bullous Skin Disorder Intensity Score — Pfütze, Niedermeier, Hertl & Eming, 2007

Purpose
Quantifies pemphigus intensity combining weighted skin extent, oral extent and patient-reported discomfort when eating and drinking. Used alongside the PDAI in trials and in the EADV S2k guideline.
Population
Pemphigus vulgaris and foliaceus; also applied to other autoimmune bullous diseases (e.g. bullous pemphigoid) although validated in pemphigus. Any age.
Formula
Skin = Σ (% BSA × weight: 1.5 erosive/exudative or blisters or Nikolsky+ · 1 erosive dry · 0.5 re-epithelialised), max 150. Oral extent = sites involved (0–11). Oral severity = Σ (food weight 1–9 × 0 / 0.5 / 1), max 45. Total 0–206.
Severity thresholds
Total ≤ 17 mild (“moderate”) · > 17–53 moderate (“significant”) · > 53 severe (“extensive”) — Boulard et al. 2016 (1st/3rd quartiles, newly diagnosed pemphigus). Not agreed as definitive (Murrell 2020).
🩻 Skin involvement — weighted body surface area

Estimate the % of body surface area (BSA) affected by each lesion quality using the rule of nines (head/neck 9 · each arm 9 · each leg 18 · anterior trunk 18 · posterior trunk 18 · genitals 1). The three percentages may not exceed 100% in total.

The sum of the three percentages exceeds 100% BSA.
Skin subtotal 0 / 150
👄 Oral involvement — extent (11 sites)

Tap each oral site where a lesion is present (1 point per site, regardless of severity).

Oral extent subtotal 0 / 11
🍽️ Oral involvement — severity (eating & drinking questionnaire)

Ask the patient whether pain or bleeding occurs when consuming each food or drink. Each answer is multiplied by the food’s weight (1 = softest … 9 = hardest).

  • 0Never — no pain or bleeding
  • 0.5Sometimes — pain or bleeding on some occasions
  • 1Always — pain or bleeding every time
Oral severity subtotal 0 / 45
📚 References
  1. Pfütze M, Niedermeier A, Hertl M, Eming R. Introducing a novel Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) in pemphigus. Eur J Dermatol. 2007;17(1):4–11.
  2. Rosenbach M, Murrell DF, Bystryn JC, et al. Reliability and convergent validity of two outcome instruments for pemphigus. J Invest Dermatol. 2009;129(10):2404–10.
  3. Boulard C, Duvert Lehembre S, Picard-Dahan C, et al.; International Pemphigus Study Group. Calculation of cut-off values based on the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI) pemphigus scoring systems for defining moderate, significant and extensive types of pemphigus. Br J Dermatol. 2016;175(1):142–9.
  4. Hébert V, Boulard C, Houivet E, et al. Large international validation of ABSIS and PDAI pemphigus severity scores. J Invest Dermatol. 2019;139(1):31–7.
  5. Joly P, Horvath B, Patsatsi A, et al. Updated S2K guidelines on the management of pemphigus vulgaris and foliaceus initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2020;34(9):1900–13.
  6. Murrell DF, Peña S, Joly P, et al. Diagnosis and management of pemphigus: recommendations of an international panel of experts. J Am Acad Dermatol. 2020;82(3):575–85.e1.
Clinical decision support only. This tool is intended to assist clinical assessment and does not replace professional judgment. Always interpret results in the context of the individual patient.