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The Objective Severity Assessment of Atopic Dermatitis Score
An Objective Measure Using Permeability Barrier Function and Stratum Corneum Hydration With Computer-Assisted Estimates for Extent of Disease
Jeffrey L. Sugarman, MD*;
Joachim W. Fluhr, MD*;
Ashley J. Fowler, MD;
Thomas Bruckner, MD;
Thomas L. Diepgen, MD;
Mary L. Williams, MD
Arch Dermatol. 2003;139:1417-1422.
Objectives Clinical scores used to assess the severity of atopic dermatitis (AD) rely entirely on subjective criteria to evaluate the severity of lesions and the extent of involvement. The aim of this study was to develop an objective measure of AD severity by measuring stratum corneum (SC) functions and by using computer-assisted estimates of involved body surface areas (BSAs).
Design Barrier function of the SC was assessed by measuring transepidermal water loss, and SC hydration was assessed by measuring capacitance. The extent of disease was assessed using a computer-assisted algorithm.
Patients A total of 38 sequential volunteers aged 4 months to 18 years (25 girls, 13 boys) with mild to severe AD at a university outpatient pediatric dermatology clinic.
Main Outcome Measures The computer-assisted method for estimating BSA was compared with estimates using the "rule of nines." The Objective Severity Assessment of Atopic Dermatitis (OSAAD) score, derived from measurements of SC barrier function and SC hydration and normalized for extent of disease was compared with the Scoring Atopic Dermatitis (SCORAD) index.
Results Measurements of epidermal permeability barrier function and SC hydration correlated with clinical estimates of disease severity. The computer-assisted measurements of the extent of disease correlated with estimates derived from the rule of nines. The OSAAD scores correlated with the currently used instrument for AD severity, the SCORAD index.
Conclusion The OSAAD is a new AD severity score that avoids the pitfalls of currently used subjective scoring systems by using objective measures.
From the Departments of Dermatology (Drs Sugarman, Fluhr, Fowler, and Williams) and Pediatrics (Dr Williams), University of California, San Francisco; Dermatology and Medical Service, Veterans Affairs Medical Center, San Francisco (Drs Fluhr and Fowler); Dermatology, Friedrich-Schiller-University, Jena, Germany (Dr Fluhr); and Clinical Social Medicine, Center of Occupational Environmental Dermatology, University of Heidelberg, Heidelberg, Germany (Drs Bruckner and Diepgen). The byline asterisks indicate that Drs Sugarman and Fluhr contributed equally to this article and are thus joint first authors. None of the authors have any relevant financial interest in this article.
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