What happens to the severity grading by objective SCORAD if we over- or underestimate disease extent or intensity in patients with atopic dermatitis?

Background: The objective SCORing Atopic Dermatitis (SCORAD) is a widely-used clinical score for assessing the extent, intensity, and severity of atopic dermatitis (AD).

Objective: We evaluated the effect on the severity grading if extent or intensity was under-estimated or overestimated.

Materials and methods: Six-hundred and fifty-one SCORADs performed over a 40-month period were evaluated. The effect on AD severity grading of six-hundred and fifty-one SCORADs performed over a 40-month period was evaluated if disease extent or intensivity was misestimated.

Results: The effect on AD grading was generally small if extent had been misestimated by 10% or 20%. In the mild grade (n=131), 40%, 62%, and 82% would have become moderate if the intensity had been underestimated by 1, 2, and 3, respectively. In the moderate grade (n=296), 13%, 27%, and 41% would have become severe if the intensity had been underestimated by 1, 2, and 3, respectively. The grading would have become mild in 16%, 31%, and 44% if the intensity had been overestimated by 1, 2, and 3, respectively. In the severe grade (n=224), 14%, 25%, and 38% would have become moderate if the intensity had been overestimated by 1, 2, and 3, respectively.

Conclusions: The effect on AD grading is generally small if extent is misestimated. A huge difference, especially if underestimated in the mild group, would occur if intensity is misestimated. Surrogate markers of disease severity could overcome or supplement shortcoming of clinical scores in AD research.