Abstract
Visual assessment of skin reactions has long been used to evaluate the safety of chemicals and preparations that contact the skin and to meet regulatory requirements. This paper reviews the history of visual grading scales and the results of investigations into the reliability of the method. Some examples are provided illustrating the diverse array of protocols that use visual scoring to evaluate skin irritation. Further, as bioengineering methods are developed that can quantitate certain aspects of skin irritant and sensitization reactions, it is important to consider if such measures should supplement or replace visual assessment. Examples of investigations comparing the outcome of studies that use visual scoring versus bioengineering methods are discussed. These examples provide little evidence that bioengineering measures improve the overall quality of current testing methods that rely on visual assessment. In addition, such measuring techniques can add considerably to the complexity of testing protocols. When benefits and cost are weighed in the balance, the visual assessment scales popularized by Draize and others remain an effective, practical method of evaluation.
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