Correlation between Objective SCORAD and Three-Item Severity Score Used by Physicians and Objective PO-SCORAD Used by Parents/Patients in Children with Atopic Dermatitis

Long-Term Impact of Atopic Dermatitis on Quality of Life

Atopic dermatitis is an inflammatory skin condition that largely affects children. Atopic dermatitis has the potential to persist into adulthood and continue to negatively affect the lives of those who are burdened with it. This condition can have a large impact on the quality of life of those who are affected from birth through senescence. Scoring systems have been developed over time to help assess the impact that AD has on an individual's quality of life. The goal of this article is to create an overview of the quality of life scores by age group and across nationalities.

Measuring Signs of Atopic Dermatitis in Clinical Practice: A HOME-CP Consensus Statement

Importance

Outcome measurement is an essential component of value-based health care and can aid patient care, quality improvement, and clinical effectiveness evidence generation. The Harmonising Outcome Measures for Eczema Clinical Practice initiative aims to identify a list of validated, feasible, outcome measurement instruments recommended to measure atopic dermatitis (AD) in the clinical practice setting. The clinical practice set is a list of instruments that clinicians can pick and choose from to suit their needs in the context of clinical care.

Objective

To recommend instruments to measure clinical signs of AD in clinical practice.

Evidence Review

Following the predefined roadmap, a mixed methods design was implemented and incorporated systematic reviews and qualitative consensus methods. Previous systematic reviews identified few clinical signs instruments with sufficient validation for recommendation. An updated systematic review evaluating the validity of clinical signs instruments informed an international meeting to reach consensus on recommended instruments to measure AD clinical signs in clinical practice. Consensus was defined as less than 30% disagreement. An in-person consensus exercise was held in Montreal, Canada, on October 16, 2022. The 34 attendees included patient and patient advocate research partners, health care professionals, researchers, methodologists, and industry representatives.

Findings

The updated systematic review found that the Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis, and objective Scoring Atopic Dermatitis were the only instruments that demonstrated sufficient performance in all assessed measurement properties. The modified EASI and Signs Global Assessment × Body Surface Area instruments were also recommended. The EASI, Validated Investigator Global Assessment, and Investigator's Global Assessment multiplied by or measured concurrently with a body surface area measure achieved consensus in criteria and were adopted.

Conclusions and Relevance

This consensus statement by the Harmonising Outcome Measures for Eczema initiative suggests that when assessing and documenting clinical signs of AD, there are several valid and feasible instruments that can best fit a clinician's specific practice needs. These instruments should improve and standardize the documentation of signs severity, help determine the effect of treatment, facilitate the generation of clinical effectiveness evidence, and enhance the implementation of value-based health care.

Investigation of Quality of Life of Patients with Atopic Dermatitis and Quality of Life, Psychiatric Symptomatology, and Caregiver Burden of Their Mothers

BACKGROUND

The purpose of the present research was to evaluate the quality of life of patients with atopic dermatitis (AD), and that of their mothers. We compared the anxiety and depression scores and caregiving burden of mothers of patients with AD with the same scores of mothers of healthy children.

MATERIALS AND METHODS

A total of 153 patients between the ages of 2 months and 16 years with AD in our clinic, and their mothers, were contained in the patient group. An additional 141 healthy cases between the ages of 2 months and 16 years, and their mothers, were included as the control group. The Children's Dermatology Life Quality Index (CDLQI) was completed according to the children's opinions, and the Infant's Dermatitis Quality of Life Index (IDLQI), Family Dermatology Life Quality Index (FDLQI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, and Zarit Caregiver Burden (ZCB) scale were completed based on the mothers' opinions.

RESULTS

We detected a positive relationship between the SCORAD index and the IDLQI, CDLQI, and FDLQI scores of children with AD. We found that anxiety, depression, and caregiving burden in mothers of AD cases increased when mothers of AD cases were compared with mothers of healthy children (p < 0.0001, p < 0.0001, and p < 0.002, respectively). Also, based on the mothers' responses, we noted a positive correlation among the BDI, BAI, ZCB, and SCORAD index scores.

CONCLUSIONS

Our study found that the quality of life of patients with AD, and that of their mothers, was negatively affected by the disease. We also found that anxiety, depression levels (not at the clinical diagnosis level, and the caregiving burden in mothers of AD cases increased when mothers of AD cases were compared with mothers of healthy children.

Common Atopic Dermatitis Rating Scales: A Practical Approach and Brief Review [Formula: see text]

Atopic dermatitis (AD) severity measurement scales are important in clinical trials as objective outcome measures and are often required for government and private insurance plans. These scales are sometimes underused by clinicians due to a variety of factors including time constraints and lack familiarity. We conducted a literature review on the most commonly used AD measurement scales and provide succinct user guides and scoring explanations, advantages and disadvantages, and interscale comparisons.

Comparison of Patient-Oriented Eczema Measure and Patient-Oriented Scoring Atopic Dermatitis vs Eczema Area and Severity Index and other measures of atopic dermatitis: A validation study

BACKGROUND

Little is known about the measurement properties of Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) in adults with atopic dermatitis (AD). Even less is known about how PO-SCORAD performs compared with the Patient-Oriented Eczema Measure (POEM).

OBJECTIVE

To examine the measurement properties of PO-SCORAD and compare them with those of POEM.

METHODS

A prospective dermatology practice-based study of 291 patients with AD (age range, 18-72 years).

RESULTS

PO-SCORAD and POEM were moderately correlated with each other (Spearman ρ = 0.56) and had weak-moderate correlations with the Numeric Rating Scale (NRS) worst itch and average itch, Dermatology Life Quality Index (DLQI), ItchyQOL, Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI), Patient Health Questionnaire-9 (PHQ-9), and Eczema Area and Severity Index (EASI) (P < .001). POEM had significantly stronger correlations with DLQI, ItchyQOL, and EASI than did PO-SCORAD. PO-SCORAD and POEM had fair discriminant validity. Changes from baseline in PO-SCORAD and POEM were moderately correlated with each other; were weakly to strongly correlated with NRS worst itch and average itch, DLQI, ItchyQOL, PROMIS SD, PROMIS SRI, PHQ-9, and EASI; and had good test-retest reliability. There was no differential item functioning of items or floor or ceiling effects for PO-SCORAD or POEM. The thresholds for meaningful change for PO-SCORAD and POEM were -15.5 and -5.0, respectively. Median completion times for PO-SCORAD and POEM were 3 minutes and 1 minute, respectively.

CONCLUSION

PO-SCORAD and POEM had good construct and cross-cultural validity, reliability, and responsiveness in adults with AD and were feasible for use in clinical trials and practice. However, POEM had better measurement properties than PO-SCORAD.

A novel oxidative stress marker of atopic dermatitis in infants: thiol-disulfide balance

Atopic dermatitis (AD) is a chronic disease of infancy and its pathogenesis remains unclear. There are recent studies suggesting that oxidative stress could play a role in the pathophysiology of atopic dermatitis. The aim of this study was to evaluate thiol (SH)-disulfide (SS) hemostasis as a new marker of oxidative stress (OS) in infants with atopic dermatitis. Thirty-one infants with AD and 30 healthy infants were included in a prospective, cross-sectional study. PO-SCORAD Index of infants with atopic dermatitis was calculated at the time of sample collection. Total antioxidant status (TAS), total oxidant status (TOS), native thiol (-SH), total thiol (-SH + -S-S-), and disulfide (SS) were measured in the control and patient groups. SS/SH, SS/total SH, SH/total SH ratios were compared between the groups. Mean native thiol and total thiol concentrations of the patient group were lower than the control group (p = 0.012; 0.047). The mean disulfide concentration of the patient group was significantly higher than the control group (p = 0.025). SS/SH, SS/total SH, and SH/total SH ratios were significantly higher in the patient group than in the control group (p < 0.05). There was a positive correlation between the duration of the breasting of the patients and thiol concentrations (p = 0.000). In our study, we found increased oxidative stress and decreased antioxidant defense mechanisms in infants with AD. Dynamic thiol-disulfide balance in the patient group was weakened and the balance shifted towards the oxidative side. These results may shed light on etiopathogenesis of atopic dermatitis and be useful in the development of new therapeutic methods.

Validation of five patient-reported outcomes for atopic dermatitis severity in adults

BACKGROUND

Structured patient-reported outcomes of atopic dermatitis (AD) severity are not standardized in clinical practice.

OBJECTIVES

To determine the construct validity, internal consistency, cross-cultural validity and floor or ceiling effects of multiple AD severity assessments.

METHODS

This is a cross-sectional, population-based study of 2893 adults, including 602 adults who met a modified set of U.K. diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) and its objective and subjective components, and numerical rating scale (NRS)-itch. Quality of life was assessed using Short-Form (SF)-12 mental and physical health scores, Short-Form Six Dimensions (SF-6D) health utility scores and Dermatology Life Quality Index (DLQI). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS).

RESULTS

PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM all had moderate-to-strong correlations with each other and DLQI, fair-to-moderate correlations with HADS-anxiety and HADS-depression, and inverse correlations with SF-12 mental component score and SF-6D (Pearson correlations, P < 0·001). All scores showed good criterion validity as judged by anova and receiver operator characteristics. PO-SCORAD, PO-SCORAD objective subscore and POEM had similarly good internal consistency (Cronbach's alpha = 0·84, 0·82 and 0·86); the PO-SCORAD subjective subscore was less internally consistent (alpha = 0·57). All scores showed potentially poor cross-cultural validity as demonstrated by uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity for multiple items. There were floor effects for POEM, but not for the other assessments.

CONCLUSIONS

PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM appear to be valid for assessing AD severity in clinical practice. What's already known about this topic? Few studies have demonstrated the validity of the atopic dermatitis severity assessments Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), PO-SCORAD subscores, numerical rating scale (NRS)-itch and Patient-Oriented Eczema Measure (POEM). What does this study add? This study demonstrates that PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all had good construct validity in the assessment of atopic dermatitis severity in adults. Only POEM demonstrated floor effects. What are the clinical implications of this work? PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all appear to have sufficient validity to be used as assessments of atopic dermatitis severity in clinical practice.

Awareness of Atopic Dermatitis and Attitudes toward Different Types of Medical Institutions for Its Treatment among Adult Patients and the Parents of Pediatric Patients: A Survey of 500 Participants

Background

Physicians can play a crucial role in the knowledge that patients have about a disease and its prognosis. Recently, patients with atopic dermatitis (AD) are increasingly turning from western medicine to oriental herbal medicine. However, their awareness of AD and attitude toward Western medicine and oriental herbal medicine clinics are scarcely reported.

Objective

The aim of this study was to determine the understanding of AD among patients and their parents and to identify their awareness of and attitude toward Western medicine and oriental herbal medicine as treatments for AD.

Methods

An online questionnaire was administered to 500 consenting respondents with AD (age, 16~49 years) and parents of children with AD (age, 0~15 years).

Results

The mean percentage of correct answers to questions about AD was 52.54%. A parental history of AD was independently associated with higher respondent’s knowledge about the disease and its treatment. The satisfaction with treatment outcomes was highest among patients treated at private clinic of dermatology specialists (49.4%), while lowest among those treated at oriental herbal medicine clinics (38.4%). Many participants were aware that oriental herbal medicine requires a longer treatment period for a cure and does not burden the skin, while steroid phobia was seen in most of participants.

Conclusion

Physicians need to educate AD patients and their parents about the disease and its treatment. Misconceptions for Western medicine and oriental herbal medicine among AD patients and parents should be corrected to improve their prognosis.

Quality of life and disease severity in patients with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) affects quality of life (QoL) negatively in patients and their families. We examined the relationship between disease severity and QoL in patients with AD.

METHODS

Consecutive, newly referred outpatients with AD, 4 years of age or older, were assessed from January 2012 onwards by means of the dermatology life quality index (DLQI, range 0-30), the Scoring of AD (SCORAD) disease severity score (range 0-103), filaggrin gene (FLG) mutation status and paraclinical tests related to allergy.

RESULTS

A total of 250 patients with a mean age of 26.0 years were identified with complete data on DLQI; 148 (59.2%) females and 102 (40.8%) males. Of these 45.6% had asthma, 46.8% had hay fever, 22.7% had a loss-of-function mutation in FLG, and 61.9% had one or more inhalant allergic sensitizations. The correlation between SCORAD and DLQI was 0.42 (P < 0.001). After multivariate adjustment there was an increasing mean DLQI score with increasing disease severity measured by SCORAD (DLQI in mild = 5.30, moderate = 8.59 and severe = 11.94 AD), P-value for difference between groups <0.001; a higher mean DLQI among females than males (9.73 vs. 8.34), P = 0.028; and among patients reporting facial eczema (9.88 vs. 6.24), P = 0.012. No statistically significant influence on DLQI was found for hand or foot eczema, age, blood eosinophil count, allergic sensitization, asthma, hay fever, FLG mutation status and smoking. FLG null mutation status was not significantly associated with SCORAD.

CONCLUSION

AD impacts negatively on the QoL, proportional to the severity of the disease. Furthermore, female sex and facial eczema are associated with low QoL. Positive FLG null mutation status is not associated with QoL or disease severity.

Children with Dry Skin and Atopic Predisposition: Outcome Measurement with Validated Scores for Atopic Dermatitis

BACKGROUND

Dry skin is a common skin condition in childhood. Few studies exist investigating the influence of daily skin care on dry skin in infants at risk of developing atopic dermatitis (AD). We aimed to assess the effect of skin care on dry skin in this special cohort using validated scores for AD and analysis of skin microtopography.

METHODS

43 children were randomized to group 1 (G1) and group 2 (G2) and 22 infants to group 3 (G3). During 16 weeks, G1 and G3 applied daily a plant-based emollient and G2 a petrolatum-based emollient. The core outcome was assessed by Severity Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). The influence on the parents' life was evaluated by a questionnaire and microtopography by Visioscan® VC 98.

RESULTS

The SCORAD index declined significantly until week (W) 16 in all groups (p ≤ 0.041). The sleeplessness score analyzed by PO-SCORAD was highly reduced after W12 in G1 and after W16 in G2 (p ≤ 0.030). The influence on the parents' anxiety was reduced in G3 at W12 and W16 (p = 0.016). The Visioscan parameter scaliness strongly diminished at W4 (p ≤ 0.049) and W16 (p ≤ 0.013) in all groups.

CONCLUSIONS

This trial demonstrates improved skin conditions and sleep following daily emollient application in infants and children having dry skin and being at risk of AD. Especially parents of infants showed a reduced fear that their children might develop AD. Further studies are required to investigate the preventive effect of daily emollient therapy in this special cohort evaluating the outcome measures used in this trial.