Abstract
Background
Scoring systems for assessing the signs of atopic dermatitis (AD) are complex and difficult to interpret. Severity strata are helpful to properly interpret these assessments. We sought to confirm previously reported strata for Eczema Area and Severity Index (EASI), Scoring AD (SCORAD) and objective component of SCORAD (oSCORAD) and develop strata for the modified EASI (mEASI), Atopic Dermatitis Severity Index (ADSI) and body surface (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 4-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; kappa=0.694), mEASI (0-0.9=clear, 1-8.9=mild, 9.0-29.9=moderate, 30.0-90=severe; kappa=0.71), oSCORAD (0-7.9=clear, 8.0-23.9=mild, 24.0-37.9=moderate, 38.0-83=severe; kappa=0.70), SCORAD (0-9.9=clear, 10.0-28.9=mild, 29.0-48.9=moderate, 49.0-103=severe; kappa=0.68), ADSI (0-1.9=clear, 2-5.9=mild, 6.0-8.9=moderate and 9.0-15=severe; kappa=0.55), and BSA (0=clear, 0.1-15.9=mild, 16.0-39.9=moderate, 40.0-100=severe; kappa=0.656). oSCORAD >0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD. Similarly, SCORAD >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 5 assessments, which profoundly impact the interpretation of their scores.
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