COSMIN database

What are the best outcome measurements for atopic eczema? A systematic review

Schmitt, J., Langan, S., and Williams, H. C.
BACKGROUND: Valid and reliable outcome measurements are a prerequisite for evidence-based practice. The comparative validity and reliability of outcome measurements for assessing atopic eczema (AE) severity is unclear.

OBJECTIVE: We sought to assess the validity, reliability, sensitivity to change, and ease of use of outcome measurements for AE. We also sought to give recommendations on which outcomes to use in clinical research and for clinical monitoring.

METHODS: We performed a systematic review and survey of clinical experts and patients.

RESULTS: Twenty published outcome measurements were identified. There is evidence of adequate construct validity for 3 measurements (Severity Scoring of Atopic Dermatitis index [SCORAD], Eczema Area and Severity Index [EASI], and Three Item Severity Score), adequate internal consistency of 1 scale (Patient-oriented Eczema Measure [POEM]), adequate interobserver reliability of 5 measurements (Basic Clinical Scoring System; Nottingham Eczema Severity Score; Objective Severity Assessment of Atopic Dermatitis; Six Area, Six Sign Atopic Dermatitis severity score; and SCORAD), adequate test-retest reliability of 1 scale (POEM), and adequate sensitivity to change of 3 measurements (EASI, SCORAD, and Investigators' Global Atopic Dermatitis Assessment). Most outcome measurements have adequate content validity, as assessed by patients and experts. Data on the time to perform the assessment was identified for 8 outcome measurements. Only SCORAD, EASI, and POEM have been tested sufficiently and performed adequately.

CONCLUSION: There are too many published outcome measures for AE. Most have not been tested properly or perform adequately when tested, and their continued use hampers scientific communication.

CLINICAL IMPLICATIONS: Only SCORAD, EASI, and POEM currently perform adequately. These scales should be used in future studies
J Allergy Clin.Immunol.
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the skin and subcutaneous tissue
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
6 - Clinical rating scales
7 - Observations
ADAM - Atopic Dermatitis Assessment Measure
ADASI - Atopic Dermatitis Area and Severity Index
ADSI - Atopic Dermatitis Severity Index
BCSS - Basic Clinical Scoring System
EASI - Eczema Area and Severity Index
FSSS - Four Step Severity Score
IGADA - Investigators’ Global Atopic Dermatitis Assessment
Leicester index
NESS - Nottingham Eczema Severity Score
OSAAD - Objective Severity Assessment of Atopic Dermatitis
POEM - Patient-Oriented Eczema Measure
RL score - Rajka and Langeland score
SA-EASI - Self-Administered Eczema Area and Severity Index
SASSAD Index - Six-Area, Six-Sign Atopic Dermatitis Index
SCORAD-subjective - SCOring Atopic Dermatitis index-Subjective
SIS - Skin Intensity Score
SSS - Symptom Severity Scale
TBSA - Total Body Severity Assessment
TISS - Three Item Severity Score
WAZ-S - atopic dermatitis severity score