The Eczema Area and Severity Index-A Practical Guide

Jon M Hanifin, Wenelia Baghoomian, Erin Grinich, Yael A Leshem, Michael Jacobson, Eric Lawrence Simpson, Jon M Hanifin, Wenelia Baghoomian, Erin Grinich, Yael A Leshem, Michael Jacobson, Eric Lawrence Simpson

Abstract

Atopic dermatitis is a chronic inflammatory skin condition that affects approximately 18 million people in the United States. Assessing the extent and severity of atopic dermatitis is critical for determining baseline disease burden and treatment effectiveness for both investigators and clinicians. Considerable efforts over the past several decades have been made in developing a highly validated instrument called the Eczema Area and Severity Index (EASI). Although several guides exist for the EASI, questions continue to arise regarding its use and interpretation. This review was developed to serve as the definitive guide for the EASI and to address commonly asked questions.

Conflict of interest statement

E.L.S. reports personal fees from AbbVie, Amgen, Arena Pharmaceuticals, Aslan Pharma, Boston Consulting Group, Collective Acumen, LLC (CA), Dermira, Eli Lilly, Evidera, ExcerptaMedica, Forte Bio RX, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa Kirin Pharmaceutical Development, Leo Pharm, Medscape LLC, Pfizer, Physicians World LLC, Regeneron, Sanofi-Genzyme, Trevi Therapeutics, and WebMD. He also reports grants (or principal investigator role) from AbbVie, Amgen, Arcutis, Aslan, Corevita, Dermira, Eli Lilly, Incyte, Kyowa Hakko Kirin, Leo Pharmaceuticals, Merck, Novartis, Pfizer, Regeneron, Sanofi, and TARGET-DERM. These potential conflicts of interest have been reviewed and managed by OHSU. The other authors have no funding or conflicts of interest to declare.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Contact Dermatitis Society.

Figures

Figure 1
Figure 1
EASI score assessment and calculation.,
Figure 2
Figure 2
Area of involvement.
Figure 3
Figure 3
Examples of erythema; both images show an erythema severity score of 2.
Figure 4
Figure 4
Edema/papulation; both images show an edema/papulation severity score of 2.
Figure 5
Figure 5
Excoriation, both images show an excoriation severity score of 3.
Figure 6
Figure 6
Lichenification; both images show a lichenification severity score of 3.

References

    1. Tofte S Graeber M Cherill R, et al. . Eczema Area and Severity Index (EASI): a new tool to evaluate atopic dermatitis. J Eur Acad Dermatol Venereol 1998;11.
    1. Hanifin JM Thurston M Omoto M, et al. . The Eczema Area and Severity Index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001;10(1):11–18. doi:10.1034/j.1600-0625.2001.100102.x.
    1. Schmitt J Spuls PI Thomas KS, et al. . The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol 2014;134(4):800–807. doi:10.1016/j.jaci.2014.07.043.
    1. Schmitt J Langan S Deckert S, et al. . Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation. J Allergy Clin Immunol 2013;132(6):1337–1347. doi:10.1016/j.jaci.2013.07.008.
    1. 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(4):e17520. doi:10.1371/journal.pone.0017520.
    1. Leshem YA Hajar T Hanifin JM, et al. . What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study. Br J Dermatol 2015;172(5):1353–1357. doi:10.1111/bjd.13662.
    1. Bożek A, Reich A. Assessment of intra- and inter-rater reliability of three methods for measuring atopic dermatitis severity: EASI, objective SCORAD, and IGA. Dermatology 2017;233(1):16–22. doi:10.1159/000472711.
    1. Silverberg JI Lei D Yousaf M, et al. . What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. Br J Dermatol 2021;184(5):888–895. doi:10.1111/bjd.19457.
    1. Chopra R Vakharia PP Sacotte R, et al. . Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol 2017;177(5):1316–1321. doi:10.1111/bjd.15641.
    1. Papp K Szepietowski JC Kircik L, et al. . Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol 2021;85(4):863–872. doi:10.1016/j.jaad.2021.04.085.
    1. Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. Br J Dermatol 2002;147(5):920–925. doi:10.1046/j.1365-2133.2002.04965.x.
    1. Zhao CY Hao EY Oh DD, et al. . A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate- to dark-skinned patients. Br J Dermatol 2017;176(4):985–992. doi:10.1111/bjd.15271.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera