A practical guide to Assessment tools

used in Atopic Eczema

Sheila Ryan, RANP Dermatology

Learning Outcomes

▪ Understand assessment tools used in Atopic Eczema

▪ POEM, IGA, EASI, SCORAD

▪ Be able to identify the advantages & disadvantages

of each tool

▪ Be able to utilize each tool

POEM

▪Patient

▪Oriented

▪Eczema

▪Measure

POEM

▪Patient rather than physician view

▪ Copyright – University of Nottingham

▪ Recommended by Harmonizing Outcome Measure for Eczema (HOME)

POEM Variations

Child

Adult

Both

POEM Scoring

▪ 7 point questionnaire. ▪ Ask to rate questions on symptoms occurrence

▪ No days = 0▪ 1-2 days = 1▪ 3-4 days = 2▪ 5-6 days = 3▪ Every day = 4

▪ Maximum Score = 28

▪ 1 Question not answered - score 0▪ More than 1 not answered not valid▪ 2 answers selected in a question score the highest.

POEM Availability

▪ Centre for Evidence Based Dermatology –University of Nottingham

▪ Paper Format for download

▪ App – My Eczema Tracker

▪ Google Play/ App store

▪ Various languages

▪ English/ Chinese/ Danish/ Finnish/

French/ German/ Japanese/ Russian Spanish/ Swedish

POEM Interpretation

Score Interpretation

0-2 Clear or almost clear

3-7 Mild Eczema

8-16 Moderate Eczema

17- 24 Severe Eczema

25- 28 Very Severe Eczema

Investigators Global Assessment

Score Category

0 Clear

1 Almost Clear

2 Mild

3 Moderate

4 Severe

5-point scale

EASI

▪ Eczema

▪ Area

▪ Severity

▪ Index

▪ Available on Harmonizing Outcome Measure for Eczema (HOME) www.homeforeczema.org

▪ Hard copy and app

Area Score- EASI

4 key signs in each body region

1. Erythema (redness)

2. Oedema / papulation (swelling and bumpiness)

3. Excoriation (scratch marks)

4. Lichenification (“leatheriness”)

Score the degree of severity of each sign for each body region separately

0 None

1 Mild

2 Moderate

3 Severe

• Take an average of the severity across the involved area

• Half points may be used e.g. 2.5 except when averaging 2 limbs

• 0.5 not used – either 1 or 0• Palpation may be useful in

assessing oedema/papulation as well as lichenification

Severity Assessment

Erythema Score EASI

0 Absent

1 Mild

2 Moderate 3 Severe

Eczema on dark skin

• More difficult to assess• Erythema especially• Go 1 category above (E Simpson HOME)

Papulation/ Induration EASI

0 Absent 1 Mild

3 Severe2 Moderate

Excoriation - EASI

0 Absent 1 Mild

3 Severe2 Moderate

Lichenification - EASI

Lichenification VsPalpability

LichenifiedChronic & Firm

PalpabilityAcute & Spongy

(E Simpson HOME)

1 Mild

2 Moderate

0 Absent

3 Severe

EASI < 8

EASI > 8

EASI Interpretation

Score Interpretation

0 Clear

0.1 - 1.0 Almost Clear

1.1 – 7.0 Mild

7.1 – 21.0 Moderate

21.1 – 50.0 Severe

50.1 – 72.0 Very Severe

SCORAD

▪ SCORing Atopic Dermatitis – SCORAD▪ Validated eczema severity tool▪ Developed by European Task Force on Atopic

Dermatitis 1990

▪ Available hard copy and app

Information- SCORAD Foundation for Atopic Dermatitis

SCORAD

A-Extent SCORAD

B-Intensity SCORAD

• From representative (average) area of eczema • 0-3• 6 categories• Maximum score B - 18

Erythema Score SCORAD

0 Absent 1 Mild

2 Moderate 3 Severe

Papulation/ Induration SCORAD

0 Absent 1 Mild

2 Moderate 3 Severe

Oozing / Crusting SCORAD

0 Absent 1 Mild

2 Moderate 3 Severe

Excoriation - SCORAD0 Absent 1 Mild

2 Moderate 3 Severe

Lichenification - SCORAD

)

0 Absent

2 Moderate

1 Mild

3 Severe

Dryness SCORAD

0 Absent 1 Mild

2 Moderate

C- Subjective Symptoms SCORAD

▪ Scored by patient

▪ 2 Categories – Itch and Sleeplessness

▪ Visual analogue scale 0 – 10

▪ Maximum Score C - 20

Total Score - SCORAD

▪ A Area/5 + 7 x B Intensity /2 + C Subjective Symptoms

Thank Ewe