SCORing Atopic Dermatitis (SCORAD) Calculator

How does the SCORing Atopic Dermatitis (SCORAD) calculator work?

This health tool evaluates the extent and severity of eczema in atopic dermatitis. It is recommended to perform the SCORAD before and after treatment to determine its effectiveness. Given the nature of the condition, the fact that is a chronically developing dermatosis that is treated symptomatically, finding a mean to objectively evaluate the severity of the lesions is essential.

The SCORAD calculator comprises of three sections which are then integrated in a formula.

The area section refers to the extent of body surface area affected by eczema, based on the rule of 9 (percentages of the whole body):

■ Head and neck (up to 9%);

■ Upper extremities (up to 18% each);

■ Anterior trunk (up to 18%);

■ Back (up to 18%);

■ Lower extremities (up to 18% each);

■ Genitals (up to 1%).

The possible maximum score for this section is 100%.

The intensity section refers to the intensity of the condition and is evaluated based on six clinical signs:

■ Redness;

■ Swelling;

■ Oozing – crusting;

■ Scratch marks;

■ Skin thickening – excoriations, lichenification;

■ Dryness – independent of any inflammation present.

Each of the signs above are awarded a number of points, dependent on their perceived severity, on a scale as follows:

■ None (0);

■ Mild (1);

■ Moderate (2);

■ Severe (3).

The intensity score consists of the sum of points for each clinical sign, with a minimum of 0 and a maximum of 18.

The subjective symptoms section, which consists of pruritus (itch) and (insomnia) sleeplessness are aimed at the patient or a relative to evaluate (based on the quality of life in the past 3 days). A visual analogue scale is used, with 0 for no symptom and 10, most severe symptom. The two individual score are added to form the result for this section.

The eczema affected area result is A. The intensity result is B. The subjective symptoms section result is C. The SCORAD formula is: A/5 + 7B/2 + C . The result range is between 0 and 103.

The score was initially proposed during the European Task Force on Atopic Dermatitis at the initiative of Jean-François Stalder and Alain Taïeb to aid the standardization of clinical evaluation of atopic patients.

Currently it is often used in outpatient clinics in the assessment of atopic dermatitis. According to the original score documentation, the extent of the lesions and subjective symptoms account for around 20% of the total score each, while the intensity items account for the rest of 60%.

One of the criticisms received by the model refers to the fact that it has not been tested enough in clinical trials.

References

1) Anon. (1993) Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology; 186(1):23-31.

2) Oranje AP, Glazenburg EJ, Wolkerstorfer A, Spek FB, De Waard - Van Der. (2007) Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. British Journal of Dermatology; Vol.157(4), p.645(4).

3) Čelakovská J, Bukač J. (2013) SCORAD Reflects the Duration of Atopic Dermatitis Lesions. Indian J Dermatol; 58(3): 247.

4) Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb A. (1997) Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology; 195(1):10-9.