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Calculate the SCORing Atopic Dermatitis (SCORAD) index to assess eczema severity and guide treatment decisions.
Percentage of body surface area affected (use Rule of 9s)
Rate each characteristic from 0 (absent) to 3 (severe)
Rate each symptom from 0 (none) to 10 (worst imaginable)
Average over last 3 days/nights
Average over last 3 days/nights
The SCORing Atopic Dermatitis (SCORAD) index is a validated tool for assessing eczema (atopic dermatitis) severity. It combines objective clinical signs with patient-reported symptoms to provide a comprehensive severity score.
The percentage of body surface area affected by eczema. Use the Rule of 9s to estimate: head and neck 9%, each arm 9%, chest 9%, abdomen 9%, upper back 9%, lower back 9%, each leg front 9%, each leg back 9%, genitalia 1%. The palm (including fingers) represents approximately 1% BSA for quick estimation.
Six clinical signs rated 0-3 each:
Patient or parent reports average itch and sleep loss over the last 3 days/nights on a scale of 0-10 each. These subjective measures capture the significant impact of eczema on quality of life.
SCORAD is useful for monitoring disease progression and treatment response. A change of 8.7 points or more is considered clinically meaningful. The tool helps guide treatment escalation decisions and provides objective documentation for systemic therapy insurance authorization.
A SCORAD score of 0 represents no eczema. Scores below 25 indicate mild disease that can typically be managed with topical therapy and good skin care. There is no "normal" range as SCORAD measures disease severity in people with eczema.
SCORAD should be assessed at baseline before starting treatment and at follow-up visits to monitor response. For stable disease, assessment every 3-6 months is reasonable. During flares or treatment changes, more frequent assessment (every 2-4 weeks) may be helpful.
Yes, SCORAD is validated for use in children and adults. For young children who cannot self-report symptoms, parents or caregivers assess the subjective symptoms (itch and sleep loss) based on observation of the child's behavior.
SCORAD includes subjective symptoms (itch and sleep loss) reported by patients, while EASI (Eczema Area and Severity Index) is purely an objective clinical assessment by the physician. Both are valid tools; SCORAD may better reflect patient quality of life impact.
Systemic therapy is typically considered for moderate to severe eczema (SCORAD >25) that inadequately responds to optimized topical therapy, or when disease significantly impacts quality of life despite appropriate topical management. Newer biologics like dupilumab have changed the treatment landscape for severe disease.
The dryness component of SCORAD is specifically rated in unaffected areas of skin. This captures the generalized xerosis (dry skin) characteristic of atopic dermatitis, which affects skin barrier function throughout the body.
While SCORAD measures current disease severity, increasing subjective symptom scores (especially itch) may indicate an impending flare. Regular monitoring can help identify patterns and allow for proactive treatment adjustments before full flares develop.
A change of 8.7 points or more in SCORAD is considered the minimal clinically important difference (MCID). This represents a change that patients perceive as meaningful. For treatment success, many studies target a 50% reduction in SCORAD from baseline.
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