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

The DOI matches its Crossref record; 60 of the 63 references it cites were found in a registry or an index.

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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Background
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Method
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Background
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Background
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Background
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“Currently, AD severity in the clinics is assessed using Eczema Area Severity Index (EASI) or Scoring AD (SCORAD), which have their own limitations [1], as they rely on direct inspection of the skin and are subjected to intraand inter-observer variations depending on the assessors’ experience [2].”
Method
Filaggrin null mutations associate with increased frequencies of allergen-specific CD4+ T-helper 2 cells in patients with atopic eczema
McPherson, T., Sherman, V. J., Aslam, A., Crack, L. R., Chan, H., Lloyd-Lavery, A., Jones, L., Ardern‐Jones, M. R., & Ogg, G. S. (2010) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2010.09866.x · Cited by 25
Evaluation of selected skin barrier functions in atopic dermatitis in relation to the disease severity and pruritus
Polańska, A., Dańczak‐Pazdrowska, A., Silny, W., Jenerowicz, D., Osmola-Mańkowska, A. J., & Olek‐Hrab, K. (2012) · Advances in Dermatology and Allergology · doi:10.5114/pdia.2012.31492 · Cited by 25
“Several different scoring systems have been proposed in recent years and still new indexes have been regularly introduced to the clinical practice [13].”
Background
Atopic dermatitis is more severe in children over the age of two who have an increased body mass index
Koutroulis, I., Magnelli, L. L., Gaughan, J., Weiner, E., & Kratimenos, P. (2015) · Acta Paediatrica · doi:10.1111/apa.12970 · Cited by 24
“(EASI) have the most validity and are recommended for use in clinical practice (9).”
Background
Educational and psychological interventions for managing atopic dermatitis (eczema)
Singleton, H., Hodder, A., Almilaji, O., Ersser, S. J., Heaslip, V., O’Meara, S., Boyers, D., Roberts, A., Scott, H., Onselen, J. V., et al. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014932.pub2 · Cited by 25
House dust mite reduction in the management of atopic dermatitis. A critically appraised topic
Garritsen, F. M., ter Haar, N. M., & Spuls, P. I. (2013) · British Journal of Dermatology · doi:10.1111/bjd.12283 · Cited by 23
Verminderte berufliche Leistungsfähigkeit und Lebensqualität bei Patienten mit moderater bis schwerer Neurodermitis
Haufe, E., Abraham, S., Heratizadeh, A., Harder, I., Zink, A., Weißhaar, E., Kleinheinz, A., von Kiedrowski, R., Worm, M., Bell, M., et al. (2018) · Der Hautarzt · doi:10.1007/s00105-018-4261-z · Cited by 23
Long-term (68 weeks) administration of nemolizumab in paediatric patients aged 6–12 years with atopic dermatitis with moderate-to-severe pruritus: efficacy and safety data from a phase III study
Igarashi, A., Katsunuma, T., Nagano, Y., & Komazaki, H. (2024) · British Journal of Dermatology · doi:10.1093/bjd/ljae458 · Cited by 25
Current treatments for atopic dermatitis in Japan
Miyano, K., & Tsunemi, Y. (2020) · The Journal of Dermatology · doi:10.1111/1346-8138.15730 · Cited by 22
Are accelerometers a useful tool for measuring disease activity in children with eczema? Validity, responsiveness to change, and acceptability of use in a clinical trial setting
Wootton, C. I., Koller, K., Lawton, S., O’Leary, C., Thomas, K. S., & on behalf of the SWET study team (2012) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2012.11184.x · Cited by 22
Hwangryunhaedoktang in adult patients with Atopic Dermatitis: a randomised, double-blind, placebo-controlled, two-centre trial - study protocol
Kim, N.-K., Lee, D., Seo, H.-S., Sun, S., Oh, Y.-L., Kim, J. E., Yoon, I.-H., Seo, E.-S., Shim, G.-S., & Zaslawski, C. (2011) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-11-68 · Cited by 22
“In this equation, A is the percentage of body area with a skin rash, B is the total score of erythema, oedema, oozing, excoriation, lichenification, and xerosis, each of which was evaluated on a 4-point scale, and C is the visual analogue scale (VAS, a scale from 0 to 10) for subjective assessment of both itching and…”
A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD)
Kohn, L. L., Kang, Y., & Antaya, R. J. (2016) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2016.04.060 · Cited by 22
Current Quality-of-Life Tools Available for Use in Contact Dermatitis
Swietlik, J. M., & Reeder, M. J. (2016) · Dermatitis · doi:10.1097/der.0000000000000192 · Cited by 22
“A toolmust be responsive and sensitive to changes in QoL that are clinically significant to be beneficial to evidencebased medicine.(19,25) Other important concepts to consider when critiquing a QoL instrument include the interpretability of the measure and its associated scores and the structure of the measure.”
Background
Validation and Interpretation of Short Form 12 and Comparison with Dermatology Life Quality Index in Atopic Dermatitis in Adults
Silverberg, J. I., Gelfand, J. M., Margolis, D. J., Boguniewicz, M., Fonacier, L. S., Grayson, M. H., Ong, P. Y., Fuxench, Z. C. C., & Simpson, E. L. (2019) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2019.03.1152 · Cited by 22
Current Perspectives on the Management of Infantile Atopic Dermatitis
Davari, D. R., Nieman, E. L., McShane, D. B., & Morrell, D. S. (2020) · Journal of Asthma and Allergy · doi:10.2147/jaa.s246175 · Cited by 21
Emollients, education and quality of life: the RCPCH care pathway for children with eczema
Cox, H. E., Lloyd, K., Williams, H. C., Arkwright, P. D., Brown, T., Clark, C., Campbell, M., Gore, C., Hardman, C. M., Langford, A., et al. (2011) · Archives of Disease in Childhood · doi:10.1136/archdischild-2011-300695 · Cited by 21
Pemphigus vulgaris activity score and assessment of convergent validity.
Chams‐Davatchi, C., Rahbar, Z., Daneshpazhooh, M., Mortazavizadeh, S. M. A., Akhyani, M., Esmaili, N., & Balighi, K. (2013) · PubMed · Cited by 21
Measurement properties of the Patient-Reported Outcomes Measurement Information System Itch Questionnaire item banks in adults with atopic dermatitis
Silverberg, J. I., Lai, J., Vakharia, P. P., Patel, K. R., Singam, V., Chopra, R., Sacotte, R. M., Patel, N., Rastogi, S., Kantor, R. W., et al. (2019) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2019.11.057 · Cited by 20
Allergen Immunotherapy for Atopic Dermatitis: Is There Room for Debate?
Cox, L., & Calderón, M. A. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2015.12.018 · Cited by 20
Citation analysis did not provide a reliable assessment of core outcome set uptake
Barnes, K. L., Kirkham, J. J., Clarke, M. J., & Williamson, P. R. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.03.003 · Cited by 20
Validation of a physician global assessment tool for vitiligo extent: Results of an international vitiligo expert meeting
van Geel, N., Wolkerstorfer, A., Ezzedine, K., Pandya, A. G., Bekkenk, M. W., Grine, L., Belle, S. V., Lommerts, J. E., Hamzavi, I. H., Harris, J. E., et al. (2019) · Pigment Cell & Melanoma Research · doi:10.1111/pcmr.12784 · Cited by 20
Best emollients for eczema (BEE) – comparing four types of emollients in children with eczema: protocol for randomised trial and nested qualitative study
Ridd, M. J., Wells, S. L., Edwards, L., Santer, M., MacNeill, S., Sanderson, E., Sutton, E. J., Shaw, A. R. G., Banks, J., Garfield, K., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-033387 · Cited by 20
Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP)
Calzavara‐Pinton, P., on behalf of RADAR Group, Fortina, A. B., Bonamonte, D., Marseglia, G. L., del Giudice, M. M., Musarra, A., Nettis, E., Neri, I., Patruno, C., et al. (2021) · Italian Journal of Dermatology and Venereology · doi:10.23736/s2784-8671.20.06654-7 · Cited by 22
Systematic review and estimated cost‐efficacy of biologics compared with narrowband ultraviolet B light for the treatment of moderate to severe psoriasis and atopic dermatitis
McCoy, T., Natarelli, N., Pan, A., Shakhbazova, A., Sivamani, R. K., & Chambers, C. J. (2023) · International Journal of Dermatology · doi:10.1111/ijd.16677 · Cited by 19
Determining Effects of Superfine Sheep wool in INfantile Eczema (DESSINE): a randomized paediatric crossover study
Su, J. C., Dailey, R., Zallmann, M., Leins, E., Taresch, L., Donath, S. M., Heah, S.-M., & Lowe, A. J. (2017) · British Journal of Dermatology · doi:10.1111/bjd.15376 · Cited by 19
Treatment options for moderate to severe atopic dermatitis
Wallace, D. V. (2022) · Allergy and Asthma Proceedings · doi:10.2500/aap.2022.43.220076 · Cited by 18
Measurement properties of adult quality-of-life measurement instruments for eczema: protocol for a systematic review
Apfelbacher, C., Heinl, D., Prinsen, C. A. C., Deckert, S., Chalmers, J. R., Ofenloch, R. F., Humphreys, R., Sach, T., Chamlin, S. L., & Schmitt, J. M. (2015) · Systematic Reviews · doi:10.1186/s13643-015-0041-3 · Cited by 18
“These criteria are in accordance with the OMERACT filter [5] which has been adopted by the HOME initiative [4] and the criteria applied in a previous review on atopic eczema outcome measures [12] (Table 3).”
Method
Outcome assessment in dermatology clinical trials and cochrane reviews: call for a dermatology‐specific outcome taxonomy
Lange, T., Kottner, J., Weberschock, T. B., Hahnel, E., Apfelbacher, C., Brandstetter, S., Dreher, A., Datzmann, T., Burden‐Teh, E., Rogers, N. K., et al. (2020) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.16854 · Cited by 19
Development and validation of a photonumeric grading scale for assessing lip volume and thickness
Rossi, A. B., Nkengne, A., Stamatas, G. N., & Bertin, C. (2010) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2010.03816.x · Cited by 18
Atopic Eczema: Pathophysiological Findings as the Beginning of a New Era of Therapeutic Options
Traidl, S., Werfel, T., & Traidl‐Hoffmann, C. (2021) · Handbook of experimental pharmacology · doi:10.1007/164_2021_492 · Cited by 19
Correlation between Objective SCORAD and Three-Item Severity Score Used by Physicians and Objective PO-SCORAD Used by Parents/Patients in Children with Atopic Dermatitis
van Oosterhout, M., Janmohamed, S. R., Spierings, M., Hiddinga, J., der Spek, F. B. D. W., & Oranje, A. P. (2015) · Dermatology · doi:10.1159/000367689 · Cited by 17
Atopic Dermatitis and the Atopic March: What Is New?
Patrizi, A., Pileri, A., Bellini, F., Raone, B., Neri, I., & Ricci, G. (2011) · Journal of Allergy · doi:10.1155/2011/279425 · Cited by 17
“A recent systematic review has identified 20 different published outcome measures, but the authors state that only EASI, SCORAD, and POEM have been adequately validated and recommend using EASI or SCORAD for an objective estimate of disease severity, plus the POEM as a measurement of eczema severity from the patient’s…”
Background
Change in Quality of Life according to the Change in Atopic Dermatitis Severity
Cho, J., Lee, J. H., Suh, J., Yu, J. S., Lee, H., Park, E., Kim, H., Chang, E. Y., Kim, J., Han, Y., et al. (2012) · Pediatric Allergy and Respiratory Disease · doi:10.7581/pard.2012.22.1.86 · Cited by 17
Towards More Shared Decision Making in Dermatology: Development of Evidence-based Decision Cards for Psoriasis and Atopic Eczema Treatments
Vermeulen, F. M., van der Kraaij, G. E., Tupker, R. A., Bijlsma, A., Blaauwbroek, H., Das, F., Geltink, T., Kraan, J., Kranenburg, R., Veen, D., et al. (2020) · Acta Dermato Venereologica · doi:10.2340/00015555-3614 · Cited by 17
IGAxBSA composite for assessing disease severity and response in patients with atopic dermatitis*
Paller, A. S., Tan, J. K. L., Bagel, J., Rossi, A. B., Shumel, B. S., Zhang, H., & Abramova, A. (2021) · British Journal of Dermatology · doi:10.1111/bjd.20872 · Cited by 17
Validation of Scratching Severity as an Objective Assessment for Itch
Udkoff, J., & Silverberg, J. I. (2017) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2017.11.028 · Cited by 17
“Standardized definitions for scratching severity have been established by the European Task Force on Atopic Dermatitis during the development of the SCORAD (European Task Force on Atopic Dermatitis, 1993) with additional guidance provided for the EASI (EASI User Guide, 2017).”
MethodInfluential
Measuring long-term disease control in patients with atopic dermatitis: A validation study of well-controlled weeks
Langan, S. M., Stuart, B., Bradshaw, L., Schmitt, J., Williams, H. C., & Thomas, K. S. (2017) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2017.02.043 · Cited by 16
Self-citation
EczemaPred: A computational framework for personalised prediction of eczema severity dynamics
Hurault, G., Stalder, J. F., Méry, S., Delarue, A., Aroman, M. S., Josse, G., & Tanaka, R. J. (2022) · Clinical and Translational Allergy · doi:10.1002/clt2.12140 · Cited by 15
Patient-Reported Outcome Measures in Chronic Spontaneous Urticaria, Angioedema, and Atopic Dermatitis
Bernstein, J. A., Apfelbacher, C., Chu, D. K., Schneider, L. C., Saini, S. S., & Ben‐Shoshan, M. (2024) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2024.08.021 · Cited by 16
Tuscan Consensus on the diagnosis, treatment and follow up of adult atopic dermatitis
Russo, F., Milanesi, N., Iannone, M., Bagnoni, G., Bartoli, L., Bellini, M., Brandini, L., Buggiani, G., Cecchi, R., Cuccia, A., et al. (2020) · Giornale Italiano di Dermatologia e Venereologia · doi:10.23736/s0392-0488.19.06527-1 · Cited by 16
A randomised controlled trial of topical Kanuka honey for the treatment of psoriasis
Fingleton, J., Sheahan, D., Corin, A., Weatherall, M., & Beasley, R. W. (2014) · JRSM Open · doi:10.1177/2042533313518913 · Cited by 16
Identification and evaluation of outcome measurement instruments in pyoderma gangrenosum: a systematic review*
Lu, J. D., Hobbs, M. M., Huang, W. W.-T., Ortega‐Loayza, A. G., & Alavi, A. (2020) · British Journal of Dermatology · doi:10.1111/bjd.19027 · Cited by 16

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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