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How to use the eSCORAD

The eSCORAD uses both objective (extent and severity of lesions) and subjective criteria (pruritus and sleep loss) to assess the severity of atopic dermatitis. This is carried out in four steps:

1) First, the percentage of the skin area affected by eczema is calculated. It accounts for a maximum of 20 points of the total SCORAD score.

2) Second, the intensity of the condition, including erythema, excoriation, edema/papulation, lichenification, oozing/crust, and dryness, is then scored on a scale of 0 (absence) to 3 (severe). Intensity accounts for a maximum of 63 points of the total SCORAD score.

3) Finally, two subjective symptoms, pruritus and sleep loss, are each rated from the patient's perspective on a scale of 0 (not present) to 10 (very strong).

The subjective symptoms account for a maximum of 20 points of the total SCORAD.

In practice there is a differentiation between the SCORAD and the objective SCORAD (oSCORAD). The oSCORAD is calculated by adding the extent of the affected area and the intensity of the AD. The oSCORAD can range between 0 – 83. In addition to the oSCORAD, the SCORAD includes the subjective symptoms assessed by the patient. Therefore the SCORAD can range between 0 – 103.

Below is an example of the SCORAD assessment process in four steps.

eSCORAD Score

At the end of the page, you can see the total score of the SCORAD and oSCORAD, as well as the separate result for the extent of eczema, the intensity, and subjective symptoms.

Reference values for the SCORAD:

0 – 24 points mild atopic dermatitis

25 – 59 points moderate atopic dermatitis

above 60 points severe atopic dermatitis

Reference values for the oSCORAD:

0 – 14 points mild atopic dermatitis

15 – 39 points moderate atopic dermatitis

above 40 points severe atopic dermatitis

Exemplary calculation:

Impact of atopic dermatitis

Atopic eczema is an inflammatory skin condition characterized by patches of red, cracked, oozy or leathery skin.

The condition is chronic, prone to relapse, and often extremely pruritic. While atopic eczema may occur at any age, it is most common in childhood and severity varies throughout the life cycle. The exact cause is unclear, but it is known to result from a combination of genetic (hereditary) and environmental factors. Atopic eczema has a severely negative effect on quality of life (QoL), with patients reporting skin damage, soreness, sleep deprivation (due to itching), activity restriction and depression. The lifestyle burden should also not be underestimated with frequent doctor visits, special clothing and the need to constantly apply messy topical ointments adding to the patient distress.

Children with severe cases tend to have a smaller social circle and participate in fewer group activities than their peers. They are also at higher risk for developing depression, anxiety and other mental health disorders.

The burden is carried by parents, who report of a lack of sleep and privacy (often due to co-sleeping), treatment-related financial expenditures, and feelings of hopelessness, guilt, and depression. It is estimated that parents of children with moderate to severe atopic eczema spend up to 3 hours a day caring for their children's skin.

References

Validity study:

Kunz, B., Oranje, A. P., Labrèze, L., Stalder, J. F., Ring, J., & Taïeb, A. (1997). Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology (Basel, Switzerland), 195(1), 10–19. https://doi.org/10.1159/000245677

Rullo, V. E., Segato, A., Kirsh, A., & Sole, D. (2008). Severity scoring of atopic dermatitis: a comparison of two scoring systems. Allergologia et immunopathologia, 36(4), 205–211.

Minimal Clinically Important Difference (MCID):

Schram, M. E., Spuls, P. I., Leeflang, M. M., Lindeboom, R., Bos, J. D., & Schmitt, J. (2012). EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy, 67(1), 99–106. https://doi.org/10.1111/j.1398-9995.2011.02719.x

Silverberg, J. I., Lei, D., Yousaf, M., Janmohamed, S. R., Vakharia, P. P., Chopra, R., Chavda, R., Gabriel, S., Patel, K. R., Singam, V., Kantor, R., & Hsu, D. Y. (2021). What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. The British journal of dermatology, 184(5), 888–895. https://doi.org/10.1111/bjd.19457

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electronic Severity Scoring of

Atopic Dermatitis

eSCORAD

Atopic dermatitis assessment made

easy and quick

What is the eSCORAD?

How to use the eSCORAD

Instructions

Extent

Intensity

Subjective symptoms

eSCORAD Score

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Impact of atopic dermatitis

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