Journal Reading of Allergy and Immunology Sub Dept

Patient-Oriented SCORAD (POSCORAD): a new selfassessment scale in atopic dermatitis validated in Europe

Stalder et al Allergy 66(2011):1114-1121

Introduction
Chronic/relapsing pruritic inflammatory skin disease Dry skin

ATOPIC DERMATITIS
Significant impact
QOL Public health cost

Industrialized Countries
Children : 10 20% Adults : 1 3%

Introduction

Severity + management

ETFAD (1992) SCORAD (efficacy tx)

Characteristic AD is not similar each course

Assessment by doctor insufficient

Introduction
An effective communication tool Require greater patients involvement

Better monitoring

SELF ASSESSMENT SCALE

SA-EASI rating scale, Skin Detective scale, ADQ, POEM scale

Introduction
SAS by ETFAD

Subjectiv e symptom s

Objective symptoms

POSCORAD

To validate this scale in a large European population of adults and children To assess the consistency between SCORAD PO-SCORAD To confirm PO-SCORAD is quick and easy

Patients and Methods

Prospective, observational study

Feb 09 Jan 2010

Belgium, Denmark, Finland, France, Germany, Italy, the Netherlands, Sweden, Switzerland

The protocol was validated by independent scientific (ETFAD)

Informed Consent

Subjects and Procedures

Adults (> 18 yo) children (< 18 yo)

understand and complete the PO-SCORAD questionnaire

Disease severity : D0 and D28

Evaluation based on the same items, objective and subjective symptoms: 1. Surface area of skin affected by eczema in the last 3 days 2. Dryness of the skin without eczema 3. Evaluation of the severity of the eczema over the last 3 days (redness of skin affected by eczema, swelling, oozing/crust, scratching and thickening), 4. Pruritus and sleep loss

Evaluation Criteria and plan of Analysis

Main criteria : correlation between PO-SCORAD and SCORAD indexes at D0 for overall population

Consistency between PO-SCORAD and SCORAD, coefficient correlation > 0.7 with a lower limit of CI 95% > 0.65 The consistency between 2 scales was evaluated : Correlation between 2 scales indexes at D28 for all population D28, time period D0 D28 > 21 days and < 35 days Correlation between absolute changes in SCORAD and PO-SCORAD scores from D0-D28 D0 and D28, time period D0 D28 > 21 days and < 35 days The same correlations were also determined for adults and children subgroups

Statistical Analysis
SAS software (9.13 ver, pack 4, SAS Institute Inc., Cary, NC, USA)

Quantitative data : number of patients, missing data, mean and standard deviation, min-max.
Between group comparison : Students t-test/Wilcoxon rank sum test (nonparametric) Qualitative data : available data, missing data, total numbers, percentage Comparison adults-children : Chi-square test/exact Fisher test Correlation PO-SCORAD SCORAD at D0 and D28 : BravaisPearson correlation coefficient

Results

Discussion
Validating the ability of PO-SCORAD to self-assess AD severity Confirming the results in pilot study in a large population (75% mild-moderate, 25% severe) PO-SCORAD and SCORAD were well correlated At D0 : correlation at D0 was good, lower than that assumed in design of the protocol Post hoc analysis : both D0 and D28, the correlation between SCORAD and PO-SCORAD at D0 was higher [r=0.71 (95% CI:0.64;0.75), p<0.0001]
High involvement of patients in therapy Acquire a better knowledge of AD

Discussion
2nd evaluation: correlation coefficient 0.79
Learning by doing

High correlation between absolute changes from baseline SCORAD and PO-SCORAD PO-SCORAD assess AD accurately
A valuable tool for doctor gives good estimate of AD severity

Discussion
Present study had correlation much stronger >> previous study
Visual explanation

PO-SCORAD is easy and feasible

No significant difference between PO-SCORAD and SCORAD according to age

Discussion
POSCORAD POEM scale
Skin Detective Scale

SA-EASI

ADQ

Poor Similar Its Recent study, evaluating SA-EASI with Subjective + Adequately PO-SCORAD is easy to implement andassessment to understand,with shows counterpart POobjective validated SCORAD in 60 children with moderate to for doctor tool SCORAD strong correlation with SCORAD in all age classes

severe eczema. A study evaluating the ADQ A valuable tool for large scale epidemiological studies on correlation between ADQ and Total SA-EASI and SCORAD were well assessing AD severity, impact on QOL after patient and family, SCORAD 1 week correlated, only a moderate correlation were Difficult for especially in paediatric populations decreased Symptoms subjective Difficult for was found between the severity scores of children < pictures outcome patient 10yo SA-EASI and SCORAD

Discussion

PO - SCORAD
doctor
Can improve communication with patient May follow long term effect of tx without meet the patient

patient
easy Strong correlation with SCORAD in all ages Paediatric populations

Same language

PO-SCORAD Software

Conclusion
Validate PO-SCORAD in a large European population. PO-SCORAD correlates well with SCORAD Standardized pictures with illustrations of AD symptoms and severity easy A valuable tool for clinical practice as well as for clinical and epid studies in AD Long-term correlation of SCORAD and PO-SCORAD has not yet been explored

dr Fajar Waskito, Mkes, SpKK(K) dr Niken Indrastuti, SpKK(K) dr Mira All friends

Thank you