What is the eSCORAD?
The eSCORAD (SCORing Atopic Dermatitis) is an international accepted and standardised tool, which was developed to objectively measure the extent and severity of atopic dermatitis. Clinicians can use this tool before, during or after treatment to assess the effectiveness of medical intervention.
paper version: yes digital version: no
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.
- Select whether the patient is older or younger than 2 years old.
- Click on the circles to mark affected body regions.
- Rate what percentage (from 0 to 100%) of the skin area of the marked body regions is affected by atopic dermatitis.
Rate the intensity of symptoms, including erythema, excoriation, edema/papulation, lichenification, oozing/crust, and dryness, each on a numeric scale from 0 (absence) to 3 (severe).
Subsequently, also rate the subjective symptoms: pruritus and sleep loss, each on a scale from 0 (not present) to 10 (very strong).
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 (objective und subjective):
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
The following versions of the eSCORAD are available
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.
The eSCORAD is straight-forward to use with clear diagrams for the classification of atopic dermatitis spread and severity. SCORAD can be used by clinicians from a range of different disciplines.
The eSCORAD is a holistic measure of both the subjective and objective parameters of atopic dermatitis.
Take care of the environment and save your patient data on the online platform or as PDF files for yourself and your physicians.
The eSCORAD consists of only 3 sections, which are quick and easy to complete due to the intuitive layout.
ACCESSIBLE FROM ALL DEVICES
With DermaValue, your eSCORAD is always just a few clicks away. The application is available for PCs, tablets, smartphones, and other devices.
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