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Severity strata for Eczema Area and Severity Index ( EASI ), modified EASI , Scoring Atopic Dermatitis ( SCORAD ), objective SCORAD , Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis
Author(s) -
Chopra R.,
Vakharia P.P.,
Sacotte R.,
Patel N.,
Immaneni S.,
White T.,
Kantor R.,
Hsu D.Y.,
Silverberg J.I.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15641
Subject(s) - eczema area and severity index , atopic dermatitis , scorad , medicine , severity of illness , body surface area , dermatology , dermatology life quality index , psoriasis
Summary Background Scoring systems for assessing the signs of atopic dermatitis ( AD ) are complex and difficult to interpret. Severity strata are helpful to interpret these assessments properly. Objectives To confirm previously reported strata for the Eczema Area and Severity Index ( EASI ), Scoring Atopic Dermatitis ( SCORAD ) and the objective component of SCORAD ( oSCORAD ), and to develop strata for the modified EASI ( mEASI ), Atopic Dermatitis Severity Index ( ADSI ) and body surface area ( BSA ) for use in adults with AD. Methods Skin examination was performed in 673 adolescents and adults (age ≥ 13 years) with diagnosed AD , in a dermatology practice setting. Strata were selected using an anchoring approach based on a four‐point Investigator's Global Assessment of severity (clear of active skin lesions, mild, moderate or severe disease). Results We determined potential severity strata for EASI (0 clear, 0·1–5·9 mild, 6·0–22·9 moderate, 23·0–72 severe; κ = 0·69), mEASI (0–0·9 clear, 1–8·9 mild, 9·0–29·9 moderate, 30·0–90 severe; κ = 0·71), oSCORAD (0–7·9 clear, 8·0–23·9 mild, 24·0–37·9 moderate, 38·0–83 severe; κ = 0·70), SCORAD (0–9·9 clear, 10·0–28·9 mild, 29·0–48·9 moderate, 49·0–103 severe; κ = 0·68), ADSI (0–1·9 clear, 2–5·9 mild, 6·0–8·9 moderate, 9·0–15 severe; κ = 0·55) and BSA (0 clear, 0·1–15·9 mild, 16·0–39·9 moderate, 40·0–100 severe; κ = 0·66). oSCORAD values > 0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD . Similarly, SCORAD values > 0 were found in clear skin due to the scoring of xerosis, pruritus and sleeplessness. Similarly, mEASI and ADSI scores > 0 occurred in patients with clear skin due to scoring of pruritus. Conclusions We recommend using these strata for interpretation of their respective measures in clinical trials of AD . There are important differences between the five assessments, which profoundly impact the interpretation of their scores.