How to measure clinical signs of atopic dermatitis

Published Online: September 16, 2013

Currently there is a lack of standardization of outcome measures in atopic dermatitis (AD)-trials which hampers evidence-based communication. The international Harmonizing Outcome Measures for Eczema (HOME)-initiative defined clinical signs, symptoms, quality of life and long term control as core outcome domains for AD trials.

In an original article in The Journal of Allergy and Clinical Immunology (JACI), Schmitt et al. conducted asystematic review on measurement properties of outcome measurements for clinical signs of AD, aiming to provide evidence-based recommendations for the measurement of clinical signs in AD-trials. Validation studies on instruments measuring clinical signs of AD were graded regarding their validity, reliability, sensitivity to change/responsiveness, and interpretability. Recommendations were developed based on predefined criteria.

Out of sixteen instruments identified to assess the clinical signs of AD, the Eczema Area and Severity Index (EASI) and the Severity Scoring of Atopic Dermatitis Index (SCORAD) are the best validated instruments. The EASI has adequate validity, responsiveness, internal consistency, and intra-observer reliability, intermediate inter-observer reliability but unclear interpretability and feasibility. The SCORAD has adequate validity, responsiveness, inter-observer reliability, interpretability and unclear intra-observer reliability. The EASI and the SCORAD have the best measurement properties and are recommended for use in future clinical trials. The other 14 instruments identified are (currently) not recommended due to unclear or inadequate measurement properties.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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