A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate to dark skin patients

Abstract

Background

Atopic dermatitis (AD) assessment is more difficult in patients with skin of colour (SOC). We sought to compare the reliability of commonly used outcome measures for assessing AD in SOC patients and evaluated a novel greyscale in this population.

Method

Twenty-five AD patients each attended a one-day scoring exercise based in either Sydney or Melbourne, Australia. Each patient was scored by the same five physicians using the Eczema Area Severity Index (EASI), objective-Scoring Atopic Dermatitis score (oSCORAD), Investigator's Global Assessment (IGA) and a novel greyscale. Patients also completed the Patient-Oriented Eczema Measure (POEM) and quality of life measures. A mexameter was used for measuring baseline melanin indices. Ten random patients were re-scored to test intra-rater reliability.

Results

We included 11 light skinned patients (melanin index ≤200) and 14 SOC patients (melanin index >200) in the cohort. The inter-rater ICCs were: EASI 0.827 (95% CI 0.658-0.941) for light skin and 0.774 (95% CI 0.598-0.906) for SOC; oSCORAD 0.680 (95% CI 0.441-0.880) for light skin and 0.736 (95%CI 0.544-0.889) for SOC; IGA 0.803 (95%CI 0.618-0.932) for light skin and 0.696 (95%CI 0.490-0.868) for SOC; the greyscale had an ICC of 0.776 (95%CI: 0.601-0.907) when replacing the EASI's erythema scale for SOC patients. All scores showed excellent intra-rater reliability for all skin types. Erythema component analysis showed that erythema did not contribute to variability.

Conclusions

EASI showed excellent reliability for patients of all skin colours, and is recommended as the optimal core measure for patients with all skin colours.

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