Table 2.

Severity scales for assessment of atopic dermatitis (AD)

(modified from Lara-Corrales et al., 2019 [61])

Diagnostic index	Description of assessment	Benefits	Limitations
EASI	Validated scale utilizing 7-point assessment of disease extent in 4 defined body regions, with severity of 4 clinical signs on a 4-point scale, to a maximum score of 72	Evaluates both extent of eczema and lesion severity Good to fair intra-evaluator reliability	Less sensitive in patients with very low %BSA Inter-evaluator variability lies in the dimension of induration/papulation Patient-reported symptoms are not evaluated
SCORAD [65]	Clinically validated scale assesses disease extent based on the rule of 9s, intensity based on 6 clinical signs rated on a 4-point scale, plus patient-reported pruritus and sleep loss	Evaluates both BSA and lesion severity	Measures such as pruritus and sleep loss can be influenced by factors other than AD
PO-SCORAD [99]	Patient self-assessment scale developed based on SCORAD criteria, but optimized for use by patients and their families by the inclusion of images and other assessment support	Evaluates both BSA and lesion severity Patients can monitor AD symptoms between clinical consultations	Measures such as pruritus and sleep loss can be influenced by factors other than AD
BSA	Disease extent assessed as a percentage of total BSA		Difficult to evaluate in patients with less severe lesions, especially in the presence of xerosis Does not assess lesion severity
IGA [63]	4 or 5-point scale of global disease severity based on morphological appearance of lesions, e.g., V-IGA, a validated global assessment score	Facilitates easy, rapid assessment of AD	No standardized ISGA, with variable definitions and implementations in clinical studies
POEM [66, 100]	Validated score assessing 7 symptoms over the preceding 7 days using a 5-point scale system (to maximum of 35)	Specifically developed for AD Scores are correlated with disease severity Appropriate to assess clinical trial populations Easily utilized in routine clinical practice Increasingly used in AD studies and clinical trials	High utility in clinical studies but low utility in a dermatology clinic

AD atopic dermatitis, BSA body surface area, EASI Eczema Area and Severity Index, IGA Investigator’s Global Assessment, ISGA Investigator’s Static Global Assessment, POEM Patient-Oriented Eczema Measure, PO-SCORAD Patient-Oriented SCORing Atopic Dermatitis, SCORAD SCORing Atopic Dermatitis