How good is the Rajka and Langeland score for assessing eczema?

Atopic dermatitis (AD) is a common type of eczema seen in people of all ages, particularly children. It makes the skin inflamed, itchy and sore and affects many aspects of everyday life. There is a lot of research into different treatments, but it is hard to compare them because researchers use different ways to measure how severe the eczema is. A global attempt to agree the best measure, called the Harmonising Outcome Measures for Eczema (HOME) initiative, concluded that the Eczema Area and Severity Index (EASI) is probably the best of those that have been properly evaluated. EASI is now widely used in clinical trials but it takes quite a long time to do so it is not ideal in clinical practice. This study from the USA, sponsored by the pharmaceutical company Galderma, investigated the Rajka and Langeland (R&L) score, which is one of the oldest measures but has never been properly validated. R&L assesses just three items: body surface area (BSA, which means how much of the body is affected), intensity of itch, and disease course (how it progresses). Each of these is scored 1‐3, giving a total of 3‐9 where 9 is the most severe. They examined 427 patients with AD aged 8 to 83 years. They used various statistical tests to compare the results from the R&L score with EASI and several other eczema scoring systems, including tests that can be done by patients themselves such as Patient‐Oriented Eczema Measure (POEM). The authors concluded that R&L is not only as reliable as other tools but is also easier and faster to use in clinical practice. Linked Article:   Silverberg et al. Br J Dermatol 2021; 184 :87–95.