Validation of patient-reported global severity of atopic dermatitis in adults

Background: Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research. Objectives: We sought to validate patient-reported global AD severity in adults. Methods: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 265). Results: At baseline and follow-up, patient-reported global AD severity significantly correlated with oSCORAD (Spearman rho = 0.56 and 0.49), SCORAD (0.64 and 0.56), EASI (0.56 and 0.50), BSA (0.52 and 0.45), NRS-itch (0.60 and 0.53), POEM (0.50 and 0.48), and DLQI (0.50 and 0.49) (P < .0001 for all). Patient-reported moderate and severe AD vs mild AD were associated with significantly higher oSCORAD, SCORAD, EASI, BSA, NRS-itch, POEM, and DLQI (P<.0001 for all). There was moderate concordance between patient-reported AD severity (mild, moderate, and severe) and previously developed severity strata for oSCORAD (kappa = 0.39), SCORAD (kappa = 0.47), EASI (kappa = 0.37), NRS-itch (kappa = 0.49), POEM (kappa = 0.37), and DLQI (kappa = 0.40). Among patients with severe disease at baseline, those who reported mild or moderate disease on follow-up had significantly greater absolute reductions of oSCORAD (-23.4/-9.7/-1.8), SCORAD (-33.0/-13.2/-2.3), EASI (-17.1/-9.8/-3.2), BSA (-46%/-15%/-4%), NRS-itch (-5/-2/0), POEM (-5/-2/0), and DLQI (-8/-6/-1) than those who continued to report severe disease (Kruskal-Wallis, P.0003 for all). Conclusions: Patient-reported AD severity appears to be sufficiently valid for assessing AD severity in the clinical and epidemiological setting.