Practical Issues on Interpretation of Scoring Atopic Dermatitis: SCORAD Index, Objective SCORAD, Patient-Oriented SCORAD and Three-Item Severity Score

Abstract

The SCORAD (Index) is the best validated scoring system in atopic dermatitis (AD). Modification of the SCORAD Index has led several times to 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 from 0 to 100. The intensity part of the SCORAD consists of 6 items: erythema, oedema/papulation, excoriations, lichenification, oozing/crusts and dryness. Each item can be graded on a scale from 0 to 3. The subjective items include daily pruritus and sleeplessness. 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 maximal score of the SCORAD Index is 103. The objective SCORAD consist of the extent and the intensity items; the formula is A/5 + 7B/2. The maximal objective SCORAD score is 83 (with 10 additional points for severe disfiguring eczema of the face and hands). Patients should also evaluate their dermatitis, because their well-being is the most important aspect of treating AD. Therefore different self-assessment scores for AD patients, including the patient-oriented SCORAD, were developed. The patient-oriented SCORAD correlates well with the SCORAD Index. The Three-Item Severity (TIS) score involves the scoring of erythema (redness), oedema and excoriations (scratches) in one representative lesion. The TIS score corresponds well with the objective SCORAD and can be used as prescreening system or as a quick system in studies and is excellent for epidemiological studies.