Introduction
Atopic Dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin disorder affecting both children and adults. Reliable assessment tools are critical to monitor disease severity, plan treatment, and evaluate outcomes in clinical practice and research. The Severity Scoring of Atopic Dermatitis (SCORAD) index, developed by the European Task Force on Atopic Dermatitis (ETFAD) in 1993, is one of the most widely used clinician-administered tools for assessing AD.
This article offers a comprehensive overview of the SCORAD index, its purpose, scoring method, validation, and practical applications. Whether you’re a researcher or clinician, understanding SCORAD can help ensure accurate, evidence-based evaluation of eczema severity.
Key Features of the Scoring Atopic Dermatitis Index
Purpose and Use
The SCORAD index is designed to assess the severity of atopic dermatitis through three components:
- Extent of skin involvement (body surface area).
- Intensity of six clinical signs (e.g., erythema, edema).
- Subjective symptoms such as itch and sleep disturbance.
This multifaceted approach allows clinicians to evaluate both objective and patient-reported symptoms, making SCORAD essential for diagnosis, monitoring, and research.
Target Population
The Scoring Atopic Dermatitis is validated for use across all age groups, including:
- Children (under 13 years)
- Adolescents
- Young and middle-aged adults
- Older adults and seniors
Its broad applicability enhances its usefulness in pediatric and adult dermatology.
Domains and Sub-domains
Main Domain:
- Dermatology / Skin Health
Sub-domains:
- Extent – Body surface area affected
- Intensity – Clinical signs (e.g., oozing, lichenification)
- Subjective Symptoms – Itch and sleep disturbance
Structure
SCORAD consists of:
- 1 item for extent
- 6 items for intensity (scored 0–3 each)
- 2 items for subjective symptoms (scored 0–10 each)
Scoring Method
The SCORAD score is calculated using the following formula:
A/5 + 7B/2 + C
Where:
- A = Extent (% of body surface area, calculated via the “rule of 9s”)
- B = Intensity score (0–18)
- C = Subjective symptoms (0–20)
Score Interpretation:
- Mild AD: <25
- Moderate AD: 25–50
- Severe AD: >50
This formula provides a maximum score of 103, reflecting overall disease severity.
Administration Format
The SCORAD index can be administered in the following formats:
- Paper-based (clinician-administered)
- Digital forms (online or electronic)
- In-person interviews
Due to its clinical nature, SCORAD typically requires healthcare professionals for accurate administration.
Applications of the Scoring Atopic Dermatitis Index
SCORAD is used for:
- Screening: Identifying AD severity
- Diagnosis: Determining the clinical state
- Monitoring: Evaluating treatment effectiveness over time
- Research: Standardizing data collection in dermatology studies
Languages Available
SCORAD is available in more than 40 languages, including:
- English
- French
- Spanish
- German
- Mandarin Chinese
- Russian
- Japanese
- Portuguese
Reliability and Validity
SCORAD has been highly validated, with more than 5,000 academic citations. It shows strong:
- Construct validity
- Sensitivity to change
- Inter-rater reliability
Limitations and Considerations
Despite its many strengths, SCORAD does have limitations:
- Not a self-report tool: Requires trained clinicians
- Cultural bias: May affect interpretation of subjective symptoms
- Scoring complexity: Involves multiple steps and components
- Subjectivity: Patient-reported symptoms may vary
Nevertheless, SCORAD remains a reliable and widely used index in dermatology
Additional Resources
For more information on the SCORAD and to access the full questionnaire, visit the following resources:
- A direct link to the Original Validation Study
- You can access the questionnaire as a PDF through this link
- For inquiries, contact authors through this link
Frequently Asked Questions (FAQ)
- Is SCORAD suitable for self-reporting?
No. SCORAD is clinician-administered and requires basic training for accurate use. - How long does it take to complete the SCORAD?
Approximately 10–15 minutes, depending on clinical setup and patient cooperation. - What are common alternatives to SCORAD?
EASI (Eczema Area and Severity Index) and POEM (Patient-Oriented Eczema Measure) are commonly used complementary tools. - Is SCORAD validated for children?
Yes, SCORAD is suitable for all age groups, including pediatric patients over 18 months.
A word from ResRef
The SCORAD index is a clinician-administered tool assessing atopic dermatitis severity through three components: extent (body surface area), intensity (six clinical signs), and subjective symptoms (itch/sleep loss). While widely used and validated, it requires specialized expertise for scoring and has limitations including cultural bias, complexity, and scoring subjectivity. It is free, available in over 40 languages, and suitable for all age groups except infants under 18 months.
References
- Stalder, J.F., Taïeb, A., et al. (1993). Severity scoring of atopic dermatitis: the SCORAD index. Dermatology, 186(1), 23–31. https://doi.org/10.1159/000247298. Link
