SCORing Atopic Dermatitis (SCORAD)
DESCRIPTION:
SCORing Atopic Dermatitis is an easy-to-use clinical tool for assessing the severity of atopic dermatitis (AD). SCORAD is based on both a clinician’s assessment of the extent and severity of AD and the patient’s subjective experiences of their disease.1,2 This tool is often used before and after treatment to determine whether the treatment has been effective.3
DISEASE STATES:
Atopic dermatitis
VALIDATED USES:
Treatment monitoring in clinical trials, clinical assessment
ADMINISTRATION METHOD:
Patient, clinician
COMMONLY USED IN:
Clinical trials, clinical practice
DETAILED DESCRIPTION:
SCORAD is a composite index that allows for objective assessment of changes in AD severity over time. The 3 components to quantify AD severity are weighted differently. The extent of spread and subjective symptoms both represent 20%, or 40% of the total, and symptom intensity is 60%.1 The 3 components are typically labeled as A, B, C. Component A measures the extent of skin lesions using the rule of nines. Component B evaluates the disease intensity based on 6 specific symptoms (erythema, edema/papulation, oozing/crusts, excoriation, lichenification, dryness). The last part, component C, focuses on the patient’s subjective experience of pruritus and loss of sleep.1,2 Clinical trials may use the percent change in SCORAD from baseline as an endpoint measure of treatment efficacy.
COMPONENT A
Determining how much of the body surface area (BSA) is affected, or extent of spread, is the first step in establishing a severity score. To achieve this, the clinician, using the rule of nines, examines the 5 main body surface areas:1,2
- 9% for the head and neck, 9% for each arm, 9% for the front and back of each leg, 9% for the 4 trunk quadrants, and 1% for the genitalia
- The total area/extent score may range from 0% (none) to 100%
EXTENT OF SPREAD (BSA)1,2
| Body Regions | Body Part | Rule of 9 Weighting4 | Percent (%) BSA Affected |
|---|---|---|---|
| Head & Neck | Front | 4.5% | 0–4.5% |
| Back | 4.5%+ | 0–4.5% | |
| Upper Limbs | Left arm (front) | 4.5%+ | 0–4.5% |
| Left arm (back) | 4.5%+ | 0–4.5% | |
| Right arm (front) | 4.5%+ | 0–4.5% | |
| Right arm (back) | 4.5%+ | 0–4.5% | |
| Trunk | Chest | 9%+ | 0–9% |
| Abdomen | 9%+ | 0–9% | |
| Upper back | 9%+ | 0–9% | |
| Lower back | 9%+ | 0–9% | |
| Lower Limbs | Left leg (front) | 9%+ | 0–9% |
| Left leg (back) | 9%+ | 0–9% | |
| Right leg (front) | 9%+ | 0–9% | |
| Right leg (back) | 9%+ | 0–9% | |
| Genitalia | 1 | 1%+ | 0–1% |
| COMPONENT A Score | 2 | = | 0–100% |
COMPONENT B
Disease intensity is measured using 6 clinical signs/symptoms of AD. It utilizes a 4-point scoring system that ranges from 0 (no disease activity) to 3 (severe).1,2
| Sign/symptom | Intensity |
|---|---|
| Erythema | 0–3 |
| Swelling+ | 0–3 |
| Oozing/crusting+ | 0–3 |
| Excoriation+ | 0–3 |
| Lichenification/thickening+ | 0–3 |
| Dryness+ | 0–3 |
| COMPONENT B Score= | 0–18 |
Note: Dryness is only assessed in areas with no inflammation.
COMPONENT C
Subjective symptoms are assessed by the patient based on a scale of 0–10 for each symptom: pruritus/itching and sleeping problems. The 2 scores are added for a maximum subjective score of 20 (worst imaginable).1,2
| Sign/symptom | Intensity |
|---|---|
| Pruritus/itching | 0–10 |
| Sleeplessness+ | 0–10 |
| COMPONENT C Score= | 0–20 |
CALCULATING SCORAD The SCORAD formula is (Component A/5) + (7xComponent B/2) + (Component C), for a maximum score of 103. Disease severity is generally divided into 3 groups:1,2
- Mild disease ≤25
- Moderate disease 26–50
- Severe disease >50
VALIDITY:
The European Task Force on Atopic Dermatitis Vakharia et al. demonstrated moderate concordance observed between patient-reported severity and established severity strata.3 The Harmonising Outcome Measures for Eczema (HOME) concludes it demonstrates adequate validity, responsiveness, and internal consistency.5
LIMITATIONS:
There may be variable interrater reliability.5 The use of only 3 severity categories (mild, moderate, severe) may not capture nuanced changes in patients with AD.3
This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.
References: 1. Severity scoring of atopic dermatitis: the SCORAD Index. Consensus report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186:23-31. doi:10.1159/000247298
2. Schram ME, Spuls PI, Leeflang MMG, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012;67(1):99-106. doi:10.1111/j.1398-9995.2011.02719.x 3. Vakharia PP, Chopra R, Sacotte R, et al. Validation of patient-reported global severity of atopic dermatitis in adults. Allergy. 2018;73(2):451-458. doi:10.1111/all.13309 4. Moore RA, Popowicz P, Burns B. Rule of Nines. PubMed. StatPearls Publishing; 2024. Accessed August 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK513287/ 5. Schmitt J, Spuls PI, Thomas KS, et al. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800-807. doi:10.1016/j.jaci.2014.07.043
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