Atopic dermatitis severity: assessment scores reveal different perceptions

By Nicole MacKee
Adolescents with atopic dermatitis and their parents are more likely to agree on the severity of the condition if both parties use a simple global assessment score to measure severity, say researchers.

In a French study published recently in the Journal of the American Academy of Dermatology, 399 adolescent/parent dyads self-assessed the severity of the adolescent’s atopic dermatitis. The adolescents included in the study were aged 12 to 17 years and had been previously diagnosed with atopic dermatitis.

Adolescents were asked to rate the severity of their condi­tion using a three­-point global assessment scale, while parents rated condition severity using both the global assessment scale and the parent version of the self­-assessed patient-­oriented eczema measure (POEM).

When parents used the POEM score, they underestimated the severity reported by the adolescent in 37% of cases, and overestimated severity in 14% of cases. When the global assessment score was used by both adolescents and parents, severity was underestimated by parents in 12% of cases, and overestimated in 6% of cases.

Associate Professor John Su, paediatric dermatologist at Monash University, Eastern Health, and Murdoch Children’s Research Institute, University of Melbourne, said the scoring of atopic dermatitis was an ‘area in evolution’.

‘In clinical practice, I don’t think that validated scores are used often enough,’ Associate Professor Su told Medicine Today. ‘Some of the scores are a bit complex and many clinicians just don’t feel they have time to be doing those in routine practice.’

Although Associate Professor Su said he did not view the global assessment and POEM scores as competing tools, he agreed the global assessment rating may be more convenient for patients, parents and clinicians.

‘A patient global assessment would be a lot faster to do than having to answer 10 questions,’ he said. ‘At the same time, they are not really measuring the same things because, with POEM, you have more layers of detail. For example, questions might specifically ask about itch or about impact on sleep.’

Associate Professor Su, who is also a Fellow of the Australasian College of Dermatologists, said using validated evaluation tools to support broad agreement on the severity of an adolescent’s atopic dermatitis would help to encourage compliance with treatment, which could be challenging in adolescent patients.
J Am Acad Dermatol 2020; doi: https://doi.org/10.1016/j.jaad.2020.04.037.