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

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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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Chopra, R., & Silverberg, J. I. (2018) · Clinics in Dermatology · doi:10.1016/j.clindermatol.2018.05.012 · Cited by 83
Off-label Use of Azathioprine in Dermatology
Schram, M. E. (2011) · Archives of Dermatology · doi:10.1001/archdermatol.2011.79 · Cited by 83
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
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
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
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
“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
“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
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
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
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
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
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
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
“%) 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
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 64
“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
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
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
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
“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
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
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
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
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
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
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
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
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
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
“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
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 63
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 60
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
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
“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
“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
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 56
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
“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
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
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
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

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 › Pulmonary and Respiratory Medicine › 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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