Atopic dermatitis: Disease severity recommendations

  • For the general management of patients with atopic dermatitis, available disease severity measurement scales are not recommended for routine clinical practice, because they were not usually designed for this purpose.

Level of Evidence: II Strength of Recommendation: C 

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For measurement of disease severity, twenty-eight different scales were identified, without a single gold-standard emerging.43-56 They employ various methods that include grid patterns, objective disease features and extent, and some scales incorporate subjective disease features. The most commonly used disease severity scales are the SCORAD index, the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), and Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score.43 These scales are primarily used in clinical trials and rarely in clinical practice, as they were generally not designed for this purpose. 

Scale development in many cases included rigorous testing and evaluation of the following statistical properties: inter-and intra-rater reliability, validity (construct, content and concurrent), internal consistency reliability, responsiveness to change, and minimal clinically important difference.44,45  The available literature suggests that the SCORAD index, the EASI score, and the Patient-Oriented Eczema Measure (POEM) severity scale have been adequately tested and validated and therefore, their use can be considered when practical.44 Of note, EASI utilizes objective physician estimates of disease extent and severity, while SCORAD incorporates both objective physician estimates of extent and severity and subjective patient assessment of itch and sleep loss.50  POEM was specifically designed to measure severity from the patient perspective and utilizes seven questions regarding symptoms and their frequency.43 The Three Item Severity Scale (TISS) is another simplified scale that shows promise for future use in clinical practice, but needs further testing.44,54

Navigate section 1 of the AD guideline: Diagnosis and assessment

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. 


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