Atopic Dermatitis Knowledge Centre
- Overview
- Signs & symptoms of atopic dermatitis
- Area of the body commonly affected by atopic dermatitis
- Diagnosis
- Assessment
- General Management
- Education
Management
Assessment
Assessment of the severity of atopic dermatitis enables selection of the most appropriate treatment for an individual patient and monitoring of the response to the chosen treatment strategy. Atopic dermatitis is broadly categorised into mild, moderate or severe forms. Any single patient may experience different severities of the disease throughout its clinical course.
When evaluating the severity of the disease, a number of factors should be taken into account, including assessment of the visible signs of the condition, the body surface area affected and the duration and severity of symptoms (notably pruritus). A number of scoring systems have been reported that combine these measures in varying proportions to provide a severity rating. One widely used scoring system, developed by the European Task Force on Atopic Dermatitis, is SCORAD (SCORing Atopic Dermatitis).4 SCORAD rates the severity of a patient’s disease according to the following measures:
- extent of disease (lesion spread and intensity)
- intensity of erythema, Oedema/papulation, excoriations, lichenification, oozing/crusts and dryness
- subjective (patient reported) assessment of pruritus and sleeplessness.5
A modification to SCORAD excludes the subjective assessment, thereby providing an objective measure of disease severity.5
Other severity scores which are often utilised in clinical trials include: the Eczema Area and Severity Index (EASI); Six Area, Six Sign Atopic Dermatitis severity score (SASSAD); Three Item Severity Score; Patient-orientated Eczema Measure (POEM); and Atopic Dermatitis Severity Index (ADSI). All atopic dermatitis scoring systems vary in their complexity, the extent to which objective and subjective measures are incorporated, and the potential for between-physician variation.6-9
Unfortunately, there is a general lack of agreement as to which scoring system most accurately reflects the severity of disease. Arguably, the patient’s or their family’s perception of the disease, the features that are most troublesome to them and their impact on quality of life, provide the most valid guide for the physician when selecting an appropriate strategy.10
References:
4. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993; 186: 23-31.
5. Oranje AP, Glazenburg EJ, Wolkerstorfer A, et al. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007; 157: 645-8.
6. Schmitt J, Langan S, Williams HC. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007; 120: 1389-98.
7. Charman CR, Venn AJ, Williams HC. Reliability testing of the Six Area, Six Sign Atopic Dermatitis severity score. Br J Dermatol 2002; 146: 1057-60.
8. Hanifin JM, Thurston M, Omoto M, et al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001; 10: 11-8.
9. Holm EA, Wulf HC, Thomassen L, et al. Assessment of atopic eczema: clinical scoring and noninvasive measurements. Br J Dermatol 2007; 157: 674-80.
10. Charman CR, Venn AJ, Williams H. Measuring atopic eczema severity visually: which variables are most important to patients? Arch Dermatol 2005; 141: 1146-51; discussion 1151.
© February 2010 Astellas Pharma Europe LTD.
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The Atopic Dermatitis Knowledge centre contained within www.epgonline.org and available at www.atopicdermatitisinfo.org is intended to be for educational use only and not designed to provide medical advice or professional services.