Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score

Abstract

It is important to determine the severity of atopic dermatitis (AD) for evaluation of disease improvement after and during therapy. Scoring of the severity of AD is demanded in clinical trials. The European Task Force on Atopic Dermatitis (ETFAD) has developed the SCORAD (SCORing AD) index to create a consensus on assessment methods for AD, so that study results of different trials can be compared. However, modification of the SCORAD index has led on several occasions to wrong and incorrect use of the system. To measure the extent of AD, the rule of nines is applied on a front/back drawing of the patient's inflammatory lesions. The extent can be graded 0-100. The intensity part of the SCORAD index consists of six items: erythema, oedema/papulation, excoriations, lichenification, oozing/crusts and dryness. Each item can be graded on a scale 0-3. The subjective items include daily pruritus and sleeplessness. Both subjective items can be graded on a 10-cm visual analogue scale. The maximum subjective score is 20. All items should be filled out in the SCORAD evaluation form. The SCORAD index formula is: A/5 + 7B/2 + C. In this formula A is defined as the extent (0-100), B is defined as the intensity (0-18) and C is defined as the subjective symptoms (0-20). The maximum SCORAD score is 103. Based on training sessions by the ETFAD, the SCORAD index was modified by excluding the subjective symptoms (objective SCORAD). The objective SCORAD consists of just the extent and intensity items, the formula being A/5 + 7B/2. The maximum objective SCORAD score is 83 (plus an additional 10 bonus points). Bonus points are given for severe disfiguring eczema (on face and hands). The three-item severity (TIS) score involves the scoring of erythema (redness), oedema and excoriations (scratches) in one representative lesion, marked as R-O-S. The TIS score corresponds well with the more detailed objective SCORAD and can be used as a prescreening system or as a quick system in studies and is excellent for epidemiological studies.

Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies

“…Each item is scored on a scale from 0 to 3 based on severity, so the total score could be from 0 to 9 19, 20. If the bilateral lesions were not exactly of the same severity, the slightly more severe site was chosen for honey application.…”

The Efficacy and Safety of Long-term Oral Cyclosporine Treatment for Patients with Atopic Dermatitis

“…The age and gender, the changes in the objective SCORAD scores, the dose and duration of CsA treatment, the laboratory findings and the blood pressure were reviewed. The severity of disease was evaluated with the objective SCORAD score 16,17 . The difference between the classic SCORAD and the objective SCORAD is described in Table 1.…”

Assessment of the severity of atopic dermatitis

“…W przypadku dzieci poniżej 7. roku życia wykonuje to rodzic. Maksymalny wynik w tej skali to 103 punkty, przy czym 60% całkowitego wyniku stanowi nasilenie zmian, a po 20% rozległość i objawy subiektywne [11,12]. Ze względu na uzyskany wynik atopowe zapalenie skóry klasyfikuje się na łagodne (< 25 punktów), umiarkowane (25-50 punktów) i ciężkie (> 50 punktów) [12].…”

“…Maksymalny wynik tej skali wynosi 83 punkty, przy czym w najcięższych przypadkach można dodać 10 punktów za zmiany szpecące lub ograniczające funkcjonowanie chorego [13]. Nasilenie choroby ocenia się jako łagodne przy wyniku poniżej 15 punktów, umiarkowane pomiędzy 15 a 40 punktów i ciężkie powyżej 40 punktów, czyli inaczej niż w przypadku SCORAD [12]. Należy zwrócić uwagę, który wariant skali stosujemy, gdyż łatwo można popełnić błąd w ocenie stopnia nasilenia choroby.…”

“…Należy zwrócić uwagę, który wariant skali stosujemy, gdyż łatwo można popełnić błąd w ocenie stopnia nasilenia choroby. Takie pomyłki spotykane są w piśmiennictwie [12].…”