Background: Numerous different scoring systems have been proposed for assessing the severity of atopic dermatitis (AD). Many of these methods did not undergo proper validation and reliability testing. Objective: The aim of our study was to compare the reliability and reproducibility of the Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), and Investigator Global Assessment (IGA). Methods: On the scoring day, 10 trained dermatologists evaluated 10 adult patients with AD using the EASI, oSCORAD, and IGA. All subjects were assessed twice by each physician. Correlations between measures were analysed using the Pearson correlation coefficient. The intra-class correlation coefficient (ICC) was calculated to assess intra-rater reliability; the coefficient of variation (CV) was used to assess inter-rater variability. Results: Significant positive correlations were observed between each scale in both assessments. The ICCs for the EASI and oSCORAD were 0.71 and 0.66, respectively, indicating good reliability, while the ICC for the IGA (0.54) indicated only fair reliability. The CVs for the oSCORAD and IGA were 28.1 and 33.0, respectively, indicating moderate variability. The CV for the EASI was 66.5, indicating high variability. Conclusion: Among the 3 compared scales, the oSCORAD had the highest inter-rater reliability, whereas the EASI had the highest intra-rater reliability. None of the 3 scoring methods showed a significant advantage over the other. Thus, a reliable assessment of AD severity requires the use of at least 2 independent measurements simultaneously.

Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R: Guidelines of care for the management of atopic dermatitis. Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014;70:338-351.
Yang HJ, Jeon YH, Pyun BY: Evaluation of patient's subjective severity using various scoring system in Korean children with atopic dermatitis. Asian Pac J Allergy Immunol 2010;28:130-135.
Schmitt J, Langan S, Williams HC: What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007;120:1389-1398.
Angelova-Fischer I, Bauer A, Hipler UC, Petrov I, Kazandjieva J, Bruckner T, Diepgen T, Tsankov N, Williams M, Fischer TW, Elsner P, Fluhr JW: The objective severity assessment of atopic dermatitis (OSAAD) score: validity, reliability and sensitivity in adult patients with atopic dermatitis. Br J Dermatol 2005;153:767-773.
Hill MK, Kheirandish Pishkenari A, Braunberger TL, Armstrong AW, Dunnick CA: Recent trends in disease severity and quality of life instruments for patients with atopic dermatitis: a systematic review. J Am Acad Dermatol 2016;75:906-917.
Wolkerstorfer A, de Waard van der Spek FB, Glazenburg EJ, Mulder PG, Oranje AP: Scoring the severity of atopic dermatitis: three item severity score as a rough system for daily practice and as a pre-screening tool for studies. Acta Derm Venereol 1999;79:356-359.
Rehal B, Armstrong AW: Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985-2010. PLoS One 2011;6:e17520.
Kottner J, Audige L, Brorson S, et al: Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud 2011;48:661-671.
Haeck IM, ten Berge O, van Velsen SG, de Bruin-Weller MS, Bruijnzeel-Koomen CA, Knol MJ: Moderate correlation between quality of life and disease activity in adult patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2012;26:236-241.
Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB: Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007;157:645-648.
Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb Al: Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195:10-19.
Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M: The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001;10:11-18.
Rullo VE, Segato A, Kirsh A, Sole D: Severity scoring of atopic dermatitis: a comparison of two scoring systems. Allergol Immunopathol (Madr) 2008;36:205-211.
Futamura M, Leshem YA, Thomas KS, Nankervis H, Williams HC, Simpson EL: A systematic review of Investigator Global Assessment (IGA) in atopic dermatitis (AD) trials: many options, no standards. J Am Acad Dermatol 2016;74:288-294.
Bożek A, Reich A: Assessment of the severity of atopic dermatitis. Przegl Dermatol 2016;103:479-485.
Schmitt J, Spuls PI, Thomas KS, impson E, Furue M, Deckert S, Dohil M, Apfelbacher C, Singh JA, Chalmers J, Williams HC; HOME initiative collaborators: The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol 2014;134:800-807.
Charman C, Williams H: Outcome measures of disease severity in atopic eczema. Arch Dermatol 2000;136:763-769.
Charman C, Chambers C, Williams H: Measuring atopic dermatitis severity in randomized controlled clinical trials: what exactly are we measuring? J Invest Dermatol 2003;120:932-941.
Zhao CY, Tran AQ, Lazo-Dizon JP, Kim J, Daniel BS, Venugopal SS, Rhodes LM, Law MG, Murrell DF: A pilot comparison study of four clinician-rated atopic dermatitis severity scales. Br J Dermatol 2015;173:488-497.
Baek JH, Park CW, Choi KM, Yang YS, Lee SY, Koh JS, Chung BY, Kim HO, Park GH: The Atopic Dermatitis Antecubital Severity score: validity, reliability, and sensitivity to change in patients with atopic dermatitis. Int J Dermatol 2015;54:1382-1389.
Hon KL, Wang SS, Leung TF: What happens to the severity grading by objective SCORAD if we over- or underestimate disease extent or intensity in patients with atopic dermatitis? Int J Dermatol 2012;51:295-299.
Charman CR, Venn AJ, Williams HC: Measurement of body surface area involvement in atopic eczema: an impossible task? Br J Dermatol 1999;140:109-111.
Prinsen CA, Vohra S, Rose MR, et al: How to select outcome measurement instruments for outcomes included in a “Core Outcome Set” - a practical guideline. Trials 2016;17:449.
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