What are the best outcome measurements for atopic eczema? A systematic review

Schmitt, Jochen; Langan, Sinead; Williams, Hywel C.

doi:10.1016/j.jaci.2007.08.011

Cited by 389Dermatology and Skin DiseasesContact Dermatitis and AllergiesAsthma and respiratory diseases

What are the best outcome measurements for atopic eczema? A systematic review

Schmitt, Jochen, Langan, Sinead, Williams, Hywel C.·2007·Journal of Allergy and Clinical Immunology

DOI 10.1016/j.jaci.2007.08.011

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Abstract

Background Valid and reliable outcome measurements are a prerequisite for evidence-based practice. The comparative validity and reliability of outcome measurements for assessing atopic eczema (AE) severity is unclear.Objective We sought to assess the validity, reliability, sensitivity to change, and ease of use of outcome measurements for AE. We also sought to give recommendations on which outcomes to use in clinical research and for clinical monitoring.Methods We performed a systematic review and survey of clinical experts and patients.Results Twenty published outcome measurements were identified. There is evidence of adequate construct validity for 3 measurements (Severity Scoring of Atopic Dermatitis index [SCORAD], Eczema Area and Severity Index [EASI], and Three Item Severity Score), adequate internal consistency of 1 scale (Patient-oriented Eczema Measure [POEM]), adequate interobserver reliability of 5 measurements (Basic Clinical Scoring System; Nottingham Eczema Severity Score; Objective Severity Assessment of Atopic Dermatitis; Six Area, Six Sign Atopic Dermatitis severity score; and SCORAD), adequate test-retest reliability of 1 scale (POEM), and adequate sensitivity to change of 3 measurements (EASI, SCORAD, and Investigators' Global Atopic Dermatitis Assessment). Most outcome measurements have adequate content validity, as assessed by patients and experts. Data on the time to perform the assessment was identified for 8 outcome measurements. Only SCORAD, EASI, and POEM have been tested sufficiently and performed adequately.Conclusion There are too many published outcome measures for AE. Most have not been tested properly or perform adequately when tested, and their continued use hampers scientific communication.Clinical implications Only SCORAD, EASI, and POEM currently perform adequately. These scales should be used in future studies.

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From Roles of Parental Psychological Flexibility, Self-Compassion, and Self-Efficacy in Affecting Mental Health and Quality of Life in Parents of Children with Eczema (2023) · cites this paper as [64]

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When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council
Simpson, E. L., de Bruin-Weller, M. S., Flohr, C., Ardern‐Jones, M. R., Barbarot, S., Deleuran, M. S., Bieber, T. R. M., Vestergaard, C., Brown, S., Cork, M. J., et al. (2017) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2017.06.042 · Cited by 241 · see citing works
The harmonizing outcome measures for eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology
Schmitt, J., Apfelbacher, C., Spuls, P. I., Thomas, K. S., Simpson, E. L., Furue, M., Chalmers, J., & Williams, H. C. (2015) · Journal of Investigative Dermatology · doi:10.1038/jid.2014.320 · Cited by 230 · see citing works
“Because these instruments differ in the items and domains they include and because most instruments have not been sufﬁciently validated (Schmitt et al. , 2013), treatment effects cannot be readily compared and meta-analyses are difﬁcult, if not impossible (Schmitt et al. , 2007b).”
Self-citation
A systematic review of Investigator Global Assessment (IGA) in atopic dermatitis (AD) trials: Many options, no standards
Futamura, M., Leshem, Y. A., Thomas, K. S., Nankervis, H., Williams, H. C., & Simpson, E. L. (2015) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2015.09.062 · Cited by 220 · see citing works
JAK Inhibitors for Atopic Dermatitis: An Update
He, H., & Guttman‐Yassky, E. (2018) · American Journal of Clinical Dermatology · doi:10.1007/s40257-018-0413-2 · Cited by 213 · see citing works
Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting
Schmitt, J. M., Spuls, P. I., Boers, M., Thomas, K. S., Chalmers, J. R., Roekevisch, E., Schram, M. E., Allsopp, R., Aoki, V., Apfelbacher, C., et al. (2012) · Allergy · doi:10.1111/j.1398-9995.2012.02874.x · Cited by 192 · see citing works
“In 2007, a systematic review critically appraised the validity, reliability and ease of use of all published measures to assess the severity of atopic eczema (11) This review concluded that only three of the 20 named scales [Severity Scoring of Atopic Dermatitis Index (SCORAD) (12), Eczema area and severity index (EAS…”
BackgroundMethod
The Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD): The development and reliability testing of a novel clinical outcome measurement instrument for the severity of atopic dermatitis
Simpson, E. L., Bissonnette, R., Eichenfield, L. F., Guttman‐Yassky, E., King, B., Silverberg, J. I., Beck, L. A., Bieber, T. R. M., Reich, K., Kabashima, K., et al. (2020) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2020.04.104 · Cited by 185 · see citing works
“Dr Beck reports honoraria for advisory board or nsulting services from AbbVie, Allakos, Arena Pharmaceuticals, AstraZe and Company, LEO Pharm Sanofi, UCB, and Vimalan investigator from AbbVie, and owns stock in Pfize honoraria for advisory bo AbbVie, Almirall, Anapty Daiichi-Sankyo, Dermavan mark Pharma, Incyte, Kym M…”
Background
Core Outcome Domains for Controlled Trials and Clinical Recordkeeping in Eczema: International Multiperspective Delphi Consensus Process
Schmitt, J. M., panel, O. B. O. T. H. O. M. I. E. (. D., Langan, S., Stamm, T., & Williams, H. C. (2010) · Journal of Investigative Dermatology · doi:10.1038/jid.2010.303 · Cited by 175 · see citing works
“In another systematic review, we found that only 3 out of 20 named outcome measurements for eczema have been tested sufficiently and performed adequately in terms of validity, reliability, and ease of use (Schmitt et al., 2007).”
BackgroundMethodInfluential
Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample
Romanos, M., Gerlach, M., Warnke, A., & Schmitt, J. M. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2009.093534 · Cited by 174 · see citing works
Strategies targeting the IL-4/IL-13 axes in disease
May, R. D., & Fung, M. (2015) · Cytokine · doi:10.1016/j.cyto.2015.05.018 · Cited by 166 · see citing works
Health Outcome Measures in Atopic Dermatitis: A Systematic Review of Trends in Disease Severity and Quality-of-Life Instruments 1985–2010
Rehal, B., & Armstrong, A. W. (2011) · PLoS ONE · doi:10.1371/journal.pone.0017520 · Cited by 168 · see citing works
“To our knowledge, IGA has not been validated as an outcome measure [7].”
Background
The HOME Core outcome set for clinical trials of atopic dermatitis
Williams, H. C., Schmitt, J. M., Thomas, K. S., Spuls, P. I., Simpson, E. L., Apfelbacher, C., Chalmers, J. R., Furue, M., Katoh, N., Gerbens, L. A. A., et al. (2022) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2022.03.017 · Cited by 161 · see citing works
Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)
Chalmers, J. R., Thomas, K. S., Apfelbacher, C., Williams, H. C., Prinsen, C. A. C., Spuls, P. I., Simpson, E., Gerbens, L. A. A., Boers, M., Barbarot, S., et al. (2018) · British Journal of Dermatology · doi:10.1111/bjd.16543 · Cited by 160 · see citing works
Chinese herbal medicine for atopic eczema
Gu, S., Yang, A. W., Xue, C. C., Li, C. G., Pang, C., Zhang, W., & Williams, H. C. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008642.pub2 · Cited by 157 · see citing works
Evaluating patient-perceived control of atopic dermatitis: design, validation, and scoring of the Atopic Dermatitis Control Tool (ADCT)
Pariser, D. M., Simpson, E. L., Gadkari, A. S., Bieber, T. R. M., Margolis, D. J., Brown, T. M., Nelson, L. M., Mahajan, P. S., Reaney, M. D., Guillemin, I., et al. (2019) · Current Medical Research and Opinion · doi:10.1080/03007995.2019.1699516 · Cited by 140 · see citing works
“Beyond these, additional instruments that are available perform less adequately [15].”
Background
Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial
Schmitt, J. M., Schäkel, K., Fölster‐Holst, R., Bauer, A., Oertel, R., Augustin, M., Aberer, W., Luger, T. A., & Meurer, M. (2009) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2009.09561.x · Cited by 134 · see citing works
Nemolizumab plus topical agents in patients with atopic dermatitis (AD) and moderate‐to‐severe pruritus provide improvement in pruritus and signs of AD for up to 68 weeks: results from two phase III, long‐term studies*
Kabashima, K., Matsumura, T., Komazaki, H., Kawashima, M., & for the Nemolizumab JP01 andJP02 Study Group (2021) · British Journal of Dermatology · doi:10.1111/bjd.20873 · Cited by 134 · see citing works
Probiotics Reduce Gut Microbial Translocation and Improve Adult Atopic Dermatitis
Iemoli, E., Trabattoni, D., Parisotto, S., Borgonovo, L., Toscano, M., Rizzardini, G., Clerici, M., Ricci, E. D., Fusi, A., Vecchi, E. D., et al. (2012) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e31826a8468 · Cited by 131 · see citing works
Interventions to reduce Staphylococcus aureus in the management of atopic eczema
Birnie, A. J., Bath-Hextall, F. J., Ravenscroft, J., & Williams, H. C. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003871.pub2 · Cited by 127 · see citing works
Effect of sleep deprivation and exercise on reaction threshold in adults with peanut allergy: A randomized controlled study
Dua, S., Ruiz-García, M., Bond, S. J., Durham, S. R., Kimber, I., Mills, E. N. C., Roberts, G. C., Skypala, I. J., Wason, J. M. S., Ewan, P. W., et al. (2019) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2019.06.038 · Cited by 126 · see citing works
Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)
Chalmers, J. R., Simpson, E., Apfelbacher, C. J., Thomas, K. S., Kobyletzki, L., Schmitt, J., Singh, J. A., Svensson, Å., Williams, H. C., Abuabara, K., et al. (2016) · British Journal of Dermatology · doi:10.1111/bjd.14773 · Cited by 125 · see citing works
Self-citation
Sensitization via Healthy Skin Programs Th2 Responses in Individuals with Atopic Dermatitis
Newell, L., Polak, M. E., Perera, J., Owen, C. L., Boyd, P., Pickard, C., Howarth, P. H., Healy, E., Holloway, J. W., Friedmann, P. S., et al. (2013) · Journal of Investigative Dermatology · doi:10.1038/jid.2013.148 · Cited by 122 · see citing works
“Objective SCORAD was measured as described previously (Schmitt et al., 2007).”
Method
Dietary supplements for established atopic eczema
Bath-Hextall, F. J., Jenkinson, C., Humphreys, R., & Williams, H. C. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005205.pub3 · Cited by 121 · see citing works
Filaggrin breakdown products determine corneocyte conformation in patients with atopic dermatitis
Riethmuller, C., McAleer, M. A., Koppes, S. A., Abdayem, R., Franz, J., Haftek, M., Campbell, L., MacCallum, S. F., McLean, W. H. I., Irvine, A. D., et al. (2015) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.04.042 · Cited by 115 · see citing works
“SCORAD is a composite score on a scale of 0 to 103 that incorporates both objective physicians’ estimates of extent and severity and subjective patient or parental assessments of itch and sleep loss.(17) SCORAD is internally consistent, responsive, and interpretable and has adequate interobserver reliability (Cohen k…”
Background
Online video improves clinical outcomes in adults with atopic dermatitis: A randomized controlled trial
Armstrong, A. W., Kim, R. H., Idriss, N. Z., Larsen, L. N., & Lio, P. (2011) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2010.01.051 · Cited by 115 · see citing works
Harmonising Outcome Measures for Eczema (HOME).Report from the First International Consensus Meeting (HOME 1), 24 July 2010, Munich, Germany
Schmitt, J. M., Williams, H. C., & on behalf of the HOME Development Group (2010) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2010.10054.x · Cited by 109 · see citing works
Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)
Chalmers, J. R., Schmitt, J. M., Apfelbacher, C., Dohil, M. A., Eichenfield, L. F., Simpson, E. L., Singh, J. A., Spuls, P. I., Thomas, K. S., Admani, S., et al. (2014) · British Journal of Dermatology · doi:10.1111/bjd.13237 · Cited by 110 · see citing works
Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus: Infant eczema, sleep problems & mental health at age 10
Schmitt, J., Chen, C.-M., Apfelbacher, C., Romanos, M., Lehmann, I., Herbarth, O., Schaaf, B., Kraemer, U., von Berg, A., Wichmann, H.-E., et al. (2011) · Allergy · doi:10.1111/j.1398-9995.2010.02487.x · Cited by 131 · see citing works
“Another important limitation of our study is the lack of data on the severity of eczema based on a validated measurement (32) and the use of a validated instrument to repeatedly measure sleeping problems of all participants at each follow-up.”
Method
Infant-onset eczema in relation to mental health problems at age 10 years: Results from a prospective birth cohort study (German Infant Nutrition Intervention plus)
Schmitt, J. M., Apfelbacher, C., Chen, C., Romanos, M., Sausenthaler, S., Koletzko, S., Bauer, C., Hoffmann, U., Krämer, U., Berdel, D., et al. (2010) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2009.10.055 · Cited by 105 · see citing works
Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials
Michail, S. K., Stolfi, A., Johnson, T., & Onady, G. M. (2008) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)60290-6 · Cited by 100 · see citing works
Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort
Ballardini, N., Kull, I., Söderhäll, C., Lilja, G., Wickman, M. C., & Wahlgren, C. (2013) · British Journal of Dermatology · doi:10.1111/bjd.12196 · Cited by 99 · see citing works
Warm, Humid, and High Sun Exposure Climates Are Associated with Poorly Controlled Eczema: PEER (Pediatric Eczema Elective Registry) Cohort, 2004–2012
Sargen, M. R., Hoffstad, O., & Margolis, D. J. (2014) · Journal of Investigative Dermatology · doi:10.1038/jid.2013.274 · Cited by 99 · see citing works
“…et al., 2004; Eichenfield et al., 2002; Hanifin et al., 2001; Housman et al., 2002; Kapoor et al., 2009; Kapoor et al., 2008; Kapp et al., 2002; Schmitt et al., 2007; van Velsen et al., 2010; Wahn et al., 2002) Covariates The initial enrollment questionnaire contained 39 questions with greater…”
Background
Development of core outcome sets in hidradenitis suppurativa: systematic review of outcome measure instruments to inform the process
Ingram, J. R., Hadjieconomou, S., & Piguet, V. (2016) · British Journal of Dermatology · doi:10.1111/bjd.14475 · Cited by 98 · see citing works
Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK
Abuabara, K., Magyari, A., Hoffstad, O., Jabbar‐Lopez, Z. K., Smeeth, L. L., Williams, H. C., Gelfand, J. M., Margolis, D. J., & Langan, S. (2017) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2017.03.029 · Cited by 94 · see citing works
“Althoughmany eczema-specific severity scales have been developed and validated for assessment of patient outcomes in clinical trials, few are designed to address long-term severity (Schmitt et al., 2007).”
Background
Severe Chronic Allergic (and Related) Diseases: A Uniform Approach – A MeDALL – GA2LEN – ARIA Position Paper
In collaboration with the WHO Collaborating Center for Asthma and Rhinitis (2012) · International Archives of Allergy and Immunology · doi:10.1159/000332924 · Cited by 94 · see citing works
Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial
Goujon, C., Viguier, M. A., Staumont-Sallé, D., Bernier, C., Guillet, G., Lahfa, M., le Bouëdec, M.-C. F., Cambazard, F., Bottigioli, D., Grande, S., et al. (2017) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2017.07.007 · Cited by 95 · see citing works
What causes flares of eczema in children?
Langan, S., Silcocks, P. B. S., & Williams, H. C. (2009) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2009.09320.x · Cited by 89 · see citing works
Skin barrier impairment correlates with cutaneousStaphylococcus aureuscolonization and sensitization to skin-associated microbial antigens in adult patients with atopic dermatitis
Jinnestål, C. L., Belfrage, E., Bäck, O., Schmidtchen, A., & Sonesson, A. (2013) · International Journal of Dermatology · doi:10.1111/ijd.12198 · Cited by 85 · see citing works
Assessing the severity of atopic dermatitis in clinical trials and practice
Chopra, R., & Silverberg, J. I. (2018) · Clinics in Dermatology · doi:10.1016/j.clindermatol.2018.05.012 · Cited by 83 · see citing works
Off-label Use of Azathioprine in Dermatology
Schram, M. E. (2011) · Archives of Dermatology · doi:10.1001/archdermatol.2011.79 · Cited by 83 · see citing works
Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI)
Misery, L., Weißhaar, E., Brenaut, E., Evers, A. W. M., Huet, F., Ständer, S., Reich, A., Berardesca, E., Serra‐Baldrich, E., Wallengren, J., et al. (2019) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.16000 · Cited by 85 · see citing works
Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Hand Eczema in Adults
Barrett, A. M., Hahn-Pedersen, J. H., Kragh, N., Evans, E., & Gnanasakthy, A. (2019) · Patient · doi:10.1007/s40271-019-00373-y · Cited by 79 · see citing works
Validation of patient‐reported global severity of atopic dermatitis in adults
Vakharia, P. P., Chopra, R., Sacotte, R. M., Patel, N., Immaneni, S., White, T., Kantor, R. W., Hsu, D. Y., & Silverberg, J. I. (2017) · Allergy · doi:10.1111/all.13309 · Cited by 78 · see citing works
Therapeutic Patient Education in Children with Atopic Dermatitis: Position Paper on Objectives and Recommendations
Barbarot, S., Bernier, C., Deleuran, M. S., Raeve, L. E. D., Eichenfield, L. F., Hachem, M. E., Gelmetti, C. M., Gieler, U., Lio, P., Marcoux, D., et al. (2013) · Pediatric Dermatology · doi:10.1111/pde.12045 · Cited by 75 · see citing works
“The sharing of education tools (WAP) and evaluation scores (POSCORAD, SAEASI, patientoriented eczema measure) is encouraged (38).”
Background
Patient-Oriented SCORAD: A Self-Assessment Score in Atopic Dermatitis
Vourc’h, M., Barbarot, S., Taı̈eb, A., Diepgen, T. L., Ambonati, M., Durosier, V., Sibaud, V., & Stalder, J. F. (2009) · Dermatology · doi:10.1159/000193997 · Cited by 73 · see citing works
“They provide approaches and examples demonstrating the potential value and feasibility of SA in AD. Moreover, while acknowledging the relevance of symptoms reported by patients, the emphasis is on exclusively objective assessment and the need to involve patients.Existing tools show that SA is possible (if the material…”
Background
Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA
Bożek, A., & Reich, A. (2017) · Dermatology · doi:10.1159/000472711 · Cited by 74 · see citing works
Interventions to reduce Staphylococcus aureus in the management of eczema
George, S. M., Karanovic, S., Harrison, D. A., Rani, A., Birnie, A. J., Bath-Hextall, F. J., Ravenscroft, J., & Williams, H. C. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003871.pub3 · Cited by 70 · see citing works
Strategies for using topical corticosteroids in children and adults with eczema
Lax, S. J., Harvey, J., Axon, E., Howells, L., Santer, M., Ridd, M. J., Lawton, S., Langan, S., Roberts, A., Ahmed, A., et al. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013356.pub2 · Cited by 72 · see citing works
Scoping systematic review of treatments for eczema
Nankervis, H., Thomas, K. S., Delamere, F. M., Barbarot, S., Rogers, N. K., & Williams, H. C. (2016) · Programme Grants for Applied Research · doi:10.3310/pgfar04070 · Cited by 68 · see citing works
Bleach baths for atopic dermatitis
Bakaa, L., Pernica, J. M., Couban, R., Tackett, K. J., Burkhart, C. N., Leins, L., Smart, J. M., García‐Romero, M. T., Elizalde-Jiménez, I. G., Herd, M., et al. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.03.024 · Cited by 65 · see citing works
An educational programme for patients with psoriasis and atopic dermatitis: a prospective randomized controlled trial
Bostoen, J., Bracke, S., Keyser, S. D., & Lambert, J. (2012) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2012.11113.x · Cited by 63 · see citing works
How should an incident case of atopic dermatitis be defined? A systematic review of primary prevention studies
Simpson, E. L., Keck, L. E., Chalmers, J. R., & Williams, H. C. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2012.01.075 · Cited by 63 · see citing works
“%) included some form of a description of the criteria used to diagnose AD.”
Influential
Measurement properties of quality-of-life measurement instruments for infants, children and adolescents with eczema: a systematic review
Heinl, D., Prinsen, C. A. C., Sach, T., Drucker, A. M., Ofenloch, R. F., Flohr, C., & Apfelbacher, C. (2016) · British Journal of Dermatology · doi:10.1111/bjd.14966 · Cited by 62 · see citing works
A review of patient and carer participation and the use of qualitative research in the development of core outcome sets
Jones, J. E., Jones, L. L., Keeley, T., Calvert, M., & Mathers, J. M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0172937 · Cited by 62 · see citing works
“Schmitt et al [60] 2007 Eczema Not stated Survey 6 4 2”
Background
Preliminary Results on Clinical Effects of Probiotic Lactobacillus salivarius LS01 in Children Affected by Atopic Dermatitis
Niccoli, A. A., Artesi, A. L., Candio, F., Ceccarelli, S., Cozzali, R., Ferraro, L., Fiumana, D., Mencacci, M., Morlupo, M., Paola, P., et al. (2014) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000233 · Cited by 61 · see citing works
Effectiveness of Acupressure on Pruritus and Lichenification Associated with Atopic Dermatitis: A Pilot Trial
Lee, K. C., Keyes, A., Hensley, J. R., Gordon, J. R., Kwasny, M., West, D. P., & Lio, P. (2011) · Acupuncture in Medicine · doi:10.1136/acupmed-2011-010088 · Cited by 64 · see citing works
The Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD™): a clinical outcome measure for the severity of atopic dermatitis
Simpson, E. L., Bissonnette, R., Paller, A. S., King, B., Silverberg, J. I., Reich, K., Thyssen, J. P., Doll, H., Sun, L., DeLozier, A. M., et al. (2022) · British Journal of Dermatology · doi:10.1111/bjd.21615 · Cited by 62 · see citing works
Comparison between high‐frequency ultrasonography (Dermascan C, version 3) and histopathology in atopic dermatitis
Polańska, A., Dańczak‐Pazdrowska, A., Silny, W., Woźniak, A., Maksin, K., Jenerowicz, D., & Janicka‐Jedyńska, M. (2013) · Skin Research and Technology · doi:10.1111/srt.12064 · Cited by 59 · see citing works
“identified a total of 56 different objective measurements to asses clinical severity used in 94 trials and only three of them (EASI, POEM, SCORAD) have been validated adequately (7).”
Background
Measuring outcomes in aphasia research: A review of current practice and an agenda for standardisation
Wallace, S. J., Worrall, L., Rose, T., & Le Dorze, G. (2014) · Aphasiology · doi:10.1080/02687038.2014.930262 · Cited by 57 · see citing works
Atopic Dermatitis/Atopic Eczema
Wallach, D., & Taı̈eb, A. (2014) · Chemical immunology/Fortschritte der Allergielehre/Progress in allergy/Chemical immunology and allergy · doi:10.1159/000358606 · Cited by 57 · see citing works
Wet Wrap Therapy in Children with Moderate to Severe Atopic Dermatitis in a Multidisciplinary Treatment Program
Nicol, N. H., Boguniewicz, M., Strand, M. J., & Klinnert, M. D. (2014) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2014.04.009 · Cited by 57 · see citing works
Useful Tools for the Management of Atopic Dermatitis
Ricci, G., Dondi, A., & Patrizi, A. (2009) · American Journal of Clinical Dermatology · doi:10.2165/11310760-000000000-00000 · Cited by 57 · see citing works
Severity strata for five patient-reported outcomes in adults with atopic dermatitis
Vakharia, P. P., Chopra, R., Sacotte, R. M., Patel, N., Immaneni, S., White, T., Kantor, R. W., Hsu, D. Y., Simpson, E. L., & Silverberg, J. I. (2017) · British Journal of Dermatology · doi:10.1111/bjd.16078 · Cited by 57 · see citing works
A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis
Svensson, Å., Chambers, C., Gånemo, A., & Mitchell, S. A. (2011) · Current Medical Research and Opinion · doi:10.1185/03007995.2011.582483 · Cited by 56 · see citing works
Management of difficult and severe eczema in childhood
McAleer, M. A., Flohr, C., & Irvine, A. D. (2012) · BMJ · doi:10.1136/bmj.e4770 · Cited by 56 · see citing works
What Factors are Important to Patients when Assessing Treatment Response: An International Cross-sectional Survey
von Kobyletzki, L. B., Thomas, K. S., Schmitt, J. M., Chalmers, J. R., Deckert, S., Aoki, V., Weißhaar, E., Ojo, J., & Svensson, Å. (2016) · Acta Dermato Venereologica · doi:10.2340/00015555-2480 · Cited by 57 · see citing works
Measurement properties of three assessments of burden used in atopic dermatitis in adults
Patel, K. R., Singam, V., Vakharia, P. P., Chopra, R., Sacotte, R. M., Patel, N., Immaneni, S., Kantor, R. W., Hsu, D. Y., & Silverberg, J. I. (2018) · British Journal of Dermatology · doi:10.1111/bjd.17243 · Cited by 56 · see citing works
Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use
Schmitt, J., Buske‐Kirschbaum, A., Tesch, F., Trikojat, K., Stephan, V., Abraham, S., Bauer, A., Nemat, K., Plessow, F., & Roessner, V. (2018) · Allergy · doi:10.1111/all.13326 · Cited by 66 · see citing works
“When interpreting our findings, it also has to be considered that the objective severity of AD in infancy could not be assessed due to the lack of a validated instrument.(44) Thus, an alternative interpretation of the study results is that early antihistamine exposure reflects the severity of AD symptoms in infancy an…”
Global differences in atopic dermatitis
Suaini, N. H. A., Tan, C. P. T., Loo, E. X. L., & Tham, E. H. (2020) · Pediatric Allergy and Immunology · doi:10.1111/pai.13335 · Cited by 56 · see citing works
Probiotics Function in Preventing Atopic Dermatitis in Children
Anania, C., Brindisi, G., Martinelli, I., Bonucci, E., D’Orsi, M., Ialongo, S., Nyffenegger, A., Raso, T., Spatuzzo, M., Castro, G. D., et al. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23105409 · Cited by 61 · see citing works
Efficacy and safety of nemolizumab in paediatric patients aged 6–12 years with atopic dermatitis with moderate-to-severe pruritus: results from a phase III, randomized, double-blind, placebo-controlled, multicentre study
Igarashi, A., Katsunuma, T., Matsumura, T., Komazaki, H., for the Nemolizumab-JP04 Study Group, Takahashi, H., Miura, K., Horino, S., Yoshihara, S., Maeda, S., et al. (2023) · British Journal of Dermatology · doi:10.1093/bjd/ljad268 · Cited by 58 · see citing works
Recent trends in disease severity and quality of life instruments for patients with atopic dermatitis: A systematic review
Hill, M. K., Pishkenari, A. K., Braunberger, T. L., Armstrong, A. W., & Dunnick, C. A. (2016) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2016.07.002 · Cited by 54 · see citing works
Feeding filaggrin: effects of L-histidine supplementation in atopic dermatitis
Tan, S. P., Brown, S. B., Griffiths, C. E. M., Weller, R., & Gibbs, N. K. (2017) · Clinical Cosmetic and Investigational Dermatology · doi:10.2147/ccid.s146760 · Cited by 57 · see citing works
“Immortalized human HaCaT keratinocytes 29 of passages 35–41 (gift from Dr J. Wood, University of Dundee; origin – German Cancer Research Center (DKFZ), Heidelberg, Germany) were seeded in six-well cell culture plates (Corning Incorporated, Corning, NY, USA) in D-MEM/F-12 medium with GlutaMAX…”
Influential
Severity strata for POEM, PO-SCORAD, and DLQI in US adults with atopic dermatitis
Silverberg, J. I., Gelfand, J. M., Margolis, D. J., Fonacier, L. S., Boguniewicz, M., Schwartz, L. B., Simpson, E. L., Grayson, M. H., Ong, P. Y., & Fuxench, Z. C. C. (2018) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2018.07.004 · Cited by 55 · see citing works
“Patient-Oriented Eczema Measure has been well validated and shown to demonstrate construct validity, convergent validity, divergent validity, internal consistency, sensitivity to change, and test-retest reliability.(23,24) Patient-Oriented Eczema Measure was chosen by the Harmonizing Outcome Measures in Eczema (HOME)…”
Method
Moderate correlation between quality of life and disease activity in adult patients with atopic dermatitis
Haeck, I. M., ten Berge, O., van Velsen, S. G. A., de Bruin-Weller, M. S., Bruijnzeel-Koomen, C. A. F. M., & Knol, M. J. (2011) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2011.04043.x · Cited by 53 · see citing works
A multicentre randomised controlled trial and economic evaluation of ion-exchange water softeners for the treatment of eczema in children: the Softened Water Eczema Trial (SWET)
Thomas, K. S., Koller, K., Dean, T., O’Leary, C., Sach, T., Frost, A., Pallett, I., Crook, A. M., Meredith, S. K., Nunn, A., et al. (2011) · Health Technology Assessment · doi:10.3310/hta15080 · Cited by 53 · see citing works
Supporting Self-Care for Families of Children With Eczema With a Web-Based Intervention Plus Health Care Professional Support: Pilot Randomized Controlled Trial
Santer, M., Muller, I., Yardley, L., Burgess, H., Selinger, H., Stuart, B. L., & Little, P. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3035 · Cited by 52 · see citing works
“POEM is a patient-reported outcome that can be used by proxy (carer report), is recommended by NICE, and demonstrates good validity, repeatability, and responsiveness to change [20].”
Reliability and Convergent Validity of the Cutaneous Sarcoidosis Activity and Morphology Instrument for Assessing Cutaneous Sarcoidosis
Rosenbach, M. A., Yeung, H., Chu, E. Y., Kim, E. J., Payne, A. S., Takeshita, J., Vittorio, C. C., Wanat, K. A., Werth, V. P., & Gelfand, J. M. (2013) · JAMA Dermatology · doi:10.1001/jamadermatol.2013.60 · Cited by 50 · see citing works
Can we decide which outcomes should be measured in every clinical trial? A scoping review of the existing conceptual frameworks and processes to develop core outcome sets
Idzerda, L., Rader, T., Tugwell, P., & Boers, M. (2014) · The Journal of Rheumatology · doi:10.3899/jrheum.131308 · Cited by 47 · see citing works
Severity scoring of atopic dermatitis: a comparison of two scoring systems
Rullo, V. E. V., Segato, A. V. K., Kirsh, A., & Solé, D. (2008) · Allergologia et Immunopathologia · doi:10.1016/s0301-0546(08)72551-5 · Cited by 49 · see citing works
Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section II: Tools for Assessing the Severity of Atopic Dermatitis
Gooderham, M., Bissonnette, R., Grewal, P. S., Lansang, P., Papp, K. A., & Hong, C.-H. (2018) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/1203475418803628 · Cited by 49 · see citing works

Outcome Measures of Disease Severity in Atopic Eczema
Charman, C. R., & Williams, H. C. (2000) · Archives of Dermatology · doi:10.1001/archderm.136.6.763 · Cited by 202 · see citing works
Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation
Schmitt, J. M., Langan, S., Deckert, S., Svensson, Å., von Kobyletzki, L., Thomas, K. S., & Spuls, P. I. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.07.008 · Cited by 295 · see citing works
Evaluation of the measurement properties of symptom measurement instruments for atopic eczema: a systematic review
Gerbens, L. A. A., Prinsen, C. A. C., Chalmers, J. R., Drucker, A. M., von Kobyletzki, L. B., Limpens, J., Nankervis, H., Svensson, Å., Terwee, C. B., Zhang, M., et al. (2016) · Allergy · doi:10.1111/all.12959 · Cited by 81 · see citing works
EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference
Schram, M. E., Spuls, P. I., Leeflang, M., Lindeboom, R., Bos, J. D., & Schmitt, J. M. (2011) · Allergy · doi:10.1111/j.1398-9995.2011.02719.x · Cited by 383 · see citing works
A comparison of five ways to measure atopic dermatitis severity in adults
Silverberg, J. I., Margolis, D. J., Boguniewicz, M., Fonacier, L. S., Grayson, M. H., Ong, P. Y., Fuxench, Z. C. C., & Simpson, E. L. (2020) · British Journal of Dermatology · doi:10.1111/bjd.18657 · Cited by 42 · see citing works

Authors: Schmitt, J., Langan, S., & Williams, H. C.
Affiliations: University Hospital Carl Gustav Carus (DE)
Queen's Medical Centre (GB)
Corresponding author: Schmitt, Jochen
ORCID: Schmitt, Jochen
Williams, Hywel C.
Venue: Journal of Allergy and Clinical Immunology
Publisher: Elsevier BV
Published: 2007-12
Volume: 120
Issue: 6
Pages: 1389-1398
ISSN: 0091-6749 (ISSN-L)
DOI: 10.1016/j.jaci.2007.08.011
OpenAlex: W1977571789
Cited by: 388
References: 63
Citations by year: 2026: 4 · 2025: 8 · 2024: 19 · 2023: 14 · 2022: 19 · 2021: 22 · 2020: 29 · 2019: 21 · 2018: 22 · 2017: 27 · 2016: 25 · 2015: 20 · 2014: 28 · 2013: 31 · 2012: 22
FWCI: 2.71
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Allergy and Clinical Immunology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords: atopic dermatitis, outcome measures, disease severity assessment, SCORAD, Eczema Area and Severity Index, Patient-Oriented Eczema Measure, construct validity, reliability statistics, sensitivity to change, inter-rater reliability, test-retest reliability, content validity, patient monitoring
MeSH terms: Dermatitis, Atopic, Humans, Outcome Assessment, Health Care

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What are the best outcome measurements for atopic eczema? A systematic review

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