2019 Consensus Korean Diagnostic Guidelines to Define Severity Classification and Treatment Refractoriness for Atopic Dermatitis: Objective and Subjective Assessment of Severity

Abstract

Background: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. Objective: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. Methods: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. Results: KADA approved that AD with 16≤eczema area and severity index (EASI)＜23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. Conclusion: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need. (Ann Dermatol 31(6) 654∼661, 2019

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“…Although many studies have attempted to classify the severity of AD, a reasonable consensus has yet to be established probably due to differences between countries, races, and prevalence rates. In this context, it is very meaningful that a consensus on subjective assessment of severity was published in 2019 after discussions with experts in Korea 8 . Among various instruments utilized for AD severity assessment, the two most commonly used tools for measuring clinical signs of AD include EASI and SCORAD.…”

Clinical Implication of Serum Adiponectin Levels in Adult Patients with Atopic Dermatitis

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“…However, assessments of AD severity are somewhat arbitrary. The Korean Atopic Dermatitis Association (KADA) recently defined an eczema area and severity index (EASI) score of 16~22 as moderate AD, whereas an EASI score of ≥23 was considered severe AD 3 . They agreed to increase the severity score if the numerical rating scale for pruritus was ≥7 or the Dermatology Life Quality Index >10.…”