Methods for Determining Atopic Dermatitis Severity in Clinical Practice

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Polling on Atopic Dermatitis Diagnostic Challenges

• Primary care physicians report key challenges in diagnosing atopic dermatitis:
  • Difficulty differentiating from other skin conditions (60%)
  • Limited access to dermatology support (47%)
  • Lack of time for thorough assessment (37%)
  • Insufficient knowledge about the disease
• Carolyn Stolte, CRNP, emphasized time constraints as a major barrier with 15-minute appointments covering multiple health concerns
• Carolyn Stolte, CRNP, highlighted that skin conditions often receive lower priority compared to cardiac, renal, and other systemic issues
• Importance noted of recognizing how atopic dermatitis impacts quality of life, mental health, sleep, and potentially other health parameters such as blood pressure

Determining Atopic Dermatitis Severity

• Key severity assessment tools discussed:
  • IGA (Investigator’s Global Assessment): most important for documentation
  • EASI (Eczema Area and Severity Index): calculator available online
  • BSA (body surface area), using rule of nines
  • SCORAD (combines BSA, intensity, symptoms, itch, and sleep)
  • POEM (patient-reported symptom questionnaire)
  • DLQI (Dermatology Life Quality Index)
• For insurance coverage documentation, requirements typically include:
  • IGA score of 3-4
  • BSA of at least 10%
  • EASI score of approximately 16%
• Shawn Kwatra, MD,​ highlighted the Numeric Rating Scale (NRS) as a quick 10- to 20-second assessment tool:
  • Asks patients to rate worst itch in past 24 hours on scale of 0-10
  • Scores ≥7 correlate with severe disruptions in quality of life, sleep issues, and higher rates of anxiety/depression

Severity Assessment Details

• IGA scoring system detailed:
  • 0 = Clear (no inflammatory signs)
  • 1 = Almost clear (barely perceptible erythema, papules, slight lichenification)
  • 2 = Mild (slight but definite erythema, papules, or lichenification)
  • 3 = Moderate (clearly perceptible erythema, papulation, or lichenification)
  • 4 = Severe (marked erythema, papulation, lichenification; widespread with possible oozing, crusting, infection)
• BSA calculation using rule of nines explained:
  • Palm = 1%
  • Head and neck = 9%
  • Upper limbs = 9% each
  • Trunk = 36%
  • Genitalia = 1%
  • Lower limbs = 18% each
• Both panelists emphasized documentation requirements for therapeutic coverage