Severity strata for five patient-reported outcomes in adults with atopic dermatitis

Abstract

Summary Atopic dermatitis (AD, also known simply as eczema) is a skin disease that can cause itching (pruritus), sleep disturbance and impaired quality of life (QoL), often affecting everyday activities such as school and work, resulting in impaired mental health. During studies into eczema or when treating patients, doctors use a variety of systems that record how severe the person's eczema is. Some of these look at the physical symptoms, such as how severe the skin lesions (areas of affected skin) are. However, as mentioned above, many of the symptoms of the disease can't be measured by looking at the skin, and for these, different measurements of ‘Patient Reported Outcomes’ (PRO) are used, in which the patient answers questions about, for example, their quality of life, mood or itch severity. These measures are not always specific to eczema, and can be used across a range of skin disorders. Each PRO has a different numbers of questions, response options, and scoring systems, which can make it difficult to interpret the results across different PROs. Severity strata have been developed for some PROs, which attribute levels of severity to the results of the scores, so for example, in a PRO called POEM, a score of 0 to 7 is mild, 8 to 16 is moderate and 17 to 28 is severe. This study sought to confirm whether previously reported strata for the PRO's called POEM and DLQI are indeed accurate for adults with AD. They also sought to develop severity strata for PRO's that don't already have them: NRS-itch, mean ItchyQOL and 5-D itch scale. The authors confirm that existing strata for POEM and DLQI perform well in adult AD and suggested amendments and new strata for certain other PRO's.