COSMIN database

Outcome measures of disease severity in atopic eczema

Charman, C. and Williams, H.
BACKGROUND: An essential component of evidence-based medicine is the use of valid and reliable outcome measures in clinical trials. There is much confusion in the field of atopic eczema regarding how to best measure disease severity objectively.

OBJECTIVE: To establish the extent to which existing objective clinical scales for atopic eczema have been tested for validity, reliability, sensitivity to change, and acceptability.

DESIGN: An electronic bibliographic search was performed for published data on all currently available named atopic eczema scales.

RESULTS: Thirteen scales were identified in total. Data on construct or criterion validity were available for 10 scales. Only 5 scales had been tested for reliability (interobserver variability, intraobserver variability, or internal consistency). Data on responsiveness to change were available for 8 scales. An estimated time to administer the measure had been given for 3 scales. The only severity scale for which published data could be found on validity, reliability, sensitivity, and acceptability testing was the Severity Scoring of Atopic Dermatitis index, although problems occurred with interobserver variation of the index.

CONCLUSION: The rapidly increasing number of severity scales for atopic eczema, many of which have been inadequately tested, has made the interpretation of patient outcomes confusing, and comparison of results between studies almost impossible. Consensus among clinicians and researchers on the use of severity scales for atopic eczema should be based on evidence of adequate validity), reliability, sensitivity to change, and ease of use.
Arch Dermatol
0003-987X (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
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:
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
Costa’s SSS
EASI - Eczema Area and Severity Index
Leicester score
NESS - Nottingham Eczema Severity Score
Rajka and Langeland Scoring System
SASSAD Index - Six-Area, Six-Sign Atopic Dermatitis Index
SCORAD-subjective - SCOring Atopic Dermatitis index-Subjective
SIS - Skin Intensity Score
TBSA - Total Body Severity Assessment