Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Abstract

Background: Numerous different scoring systems have been proposed for assessing the severity of atopic dermatitis (AD). Many of these methods did not undergo proper validation and reliability testing. Objective: The aim of our study was to compare the reliability and reproducibility of the Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), and Investigator Global Assessment (IGA). Methods: On the scoring day, 10 trained dermatologists evaluated 10 adult patients with AD using the EASI, oSCORAD, and IGA. All subjects were assessed twice by each physician. Correlations between measures were analysed using the Pearson correlation coefficient. The intra-class correlation coefficient (ICC) was calculated to assess intra-rater reliability; the coefficient of variation (CV) was used to assess inter-rater variability. Results: Significant positive correlations were observed between each scale in both assessments. The ICCs for the EASI and oSCORAD were 0.71 and 0.66, respectively, indicating good reliability, while the ICC for the IGA (0.54) indicated only fair reliability. The CVs for the oSCORAD and IGA were 28.1 and 33.0, respectively, indicating moderate variability. The CV for the EASI was 66.5, indicating high variability. Conclusion: Among the 3 compared scales, the oSCORAD had the highest inter-rater reliability, whereas the EASI had the highest intra-rater reliability. None of the 3 scoring methods showed a significant advantage over the other. Thus, a reliable assessment of AD severity requires the use of at least 2 independent measurements simultaneously.

Reliability and validity of the Atopic Dermatitis Symptom Score (ADSS)

“…Several objective methods have been used to assess AD severity: SCORAD, Eczema Area and Severity Index (EASI), and Six Area, Six Sign Atopic Dermatitis (SASSAD) . A systematic review indicated that SCORAD and EASI were the most valid and reliable instruments to measure clinical signs of AD with adequate internal consistency and responsiveness .…”

“…Sign Atopic Dermatitis (SASSAD). [24][25][26] A systematic review indicated that SCORAD and EASI were the most valid and reliable instruments to measure clinical signs of AD with adequate internal consistency and responsiveness. 16 However, they are time-consuming and too complex to use every day, because they are based on physician assessment in the outpatient clinic at different intervals over a few months.…”

A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Study of Compound Glycyrrhizin Capsules Combined with a Topical Corticosteroid in Adults with Chronic Eczema

“…We also used two additional disease severity metrics. Reduction in IGA score (Supplementary Tables 2) [18] was assessed to determine treatment success rate, defined as the percentage of patients whose IGA score was reduced to 0 (clear) or 1 (almost clear) after the end of the treatment. Pruritus alleviation was assessed using the visual analogue scale score of 2.6.…”

Development and validation of a graphic 2D investigator’s global assessment instrument for grading the overall severity of atopic dermatitis in dogs

“…Additionally, these Investigator Global Assessment (IGA) tools have the clear advantage that patients are more likely to understand the meaning of the words associated with each score (the most common being “clear”, “almost clear”, “mild”, “moderate” and “severe”) rather than a SCORAD or EASI value of 20. Although a systematic review confirmed the availability of numerous global scales for the evaluation of atopic skin lesions in humans, their validation is limited, and there is an unfortunate lack of standardization between tools …”