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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Background
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Background
Comprehensive Approaches to Diagnosis and Treatment of Sensitive Skin
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Method
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Atopic Eczema (Atopic Dermatitis)
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Roles of Parental Psychological Flexibility, Self-Compassion, and Self-Efficacy in Affecting Mental Health and Quality of Life in Parents of Children with Eczema
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“The POEM score is one of the key patient-reported outcomes (PROs) in eczema-related clinical trials [64].”
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“…SCORAD index, which has been widely used as a diagnostic tool for AD, is known for its appropriate validity, responsiveness, internal consistency, and observer reliability [20, 21], but also criticized for insufcient interobserver reliability [22] and unclear interpretability and feasibility [23].”
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Method
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“Dermatologic health services researchers studied available measurement tools and concluded that of the twenty published outcomes measures for AD, only four had adequate measurement properties such as reliability and validity (Schmitt et al., 2007).”
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“Intermediate inter-rater reliability in EASI scores (Schmitt et al., 2007), as seen in the seminal Hanifin et al. (2001) paper where one rater was excluded from the analysis to improve the results, still displays large differences in EASI score.”
BackgroundMethod
Validation of the Recap of Atopic Eczema (RECAP) Measurement Instrument for Eczema Control in Adult Patients in an Asian Clinical Setting
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Retracted
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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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