Measuring Atopic Dermatitis Disease Severity: The Potential for Electronic Tools to Benefit Clinical Care

J Allergy Clin Immunol Pract. 2021 Apr;9(4):1473-1486.e2. doi: 10.1016/j.jaip.2021.02.027.


Severity of atopic dermatitis (AD) correlates with impact on health-related quality of life (HRQoL), work productivity, and burden on health systems. Tools to measure severity inform regulatory approval, drug access, and value- or measurement-based care. A core set of instruments for measuring AD has been established. Clinician-reported tools are divided broadly into multi-item global estimates or precise calculators that also weigh affected corporeal surfaces. Increasingly, subjective patient-reported outcomes are valued, with the potential to capture vast amounts of health-related data. Patient-reported outcomes can be disease-agnostic, skin-related, or AD-specific, and evaluate global disease, itch severity, long-term control, or overall HRQoL. Patient-reported outcomes are expansive in number; therefore, item banks and adaptive digital user interfaces will be increasingly needed, along with capacity to store and analyze data. Technologies for AD include tools for communication, severity assessment, or data exchange, as well as electronic health records (EHRs). For clinicians, a limited number of applications exist, with relatively poor interoperability with EHRs to date. For patients, a growing number of mobile health (mHealth) applications exhibit variable compliance with international guidelines for self-management. Data privacy and information security governance are key considerations in the development of information technologies for AD. Integrated and streamlined digital operational processes for disease measurements may build capacity for high value and efficient care of patients with AD across the globe.

Keywords: Atopic dermatitis; Dermatology Life Quality Index; Digital health; Eczema Area and Severity Score; Electronic tool; Health-related quality of life; Measurement-based care; Patient-Oriented Eczema Measure; Patient-reported outcome measures; Scoring Atopic Dermatitis; Severity scores; Validated Investigator Global Assessment for Atopic Dermatitis.

MeSH terms

  • Dermatitis, Atopic* / diagnosis
  • Dermatitis, Atopic* / epidemiology
  • Dermatitis, Atopic* / therapy
  • Eczema*
  • Electronics
  • Humans
  • Quality of Life
  • Severity of Illness Index