Eczema severity assessment

NICE (2007) recommends that clinicians should consider using the assessment tools to measure eczema severity, psychological and psychosocial well-being and quality of life. However, the tools used should be easy-to-use validated tools which will aid clinical management. Eczema severity assessment and measurement tools should aid the clinician to ascertain the level of severity of eczema and the effects of treatment. Time-consuming and cumbersome tools may not necessarily be effective in day-to-day clinical practice. A selection of the commonly used tools to assess the impact of atopic eczema in children, recommended by NICE (2007), is outlined in Table 9.3.

Table 9.3 Eczema severity assessment scales.   Assessment tool Description   Visual analogue scales Use a 0–10 scale to capture the child/patient/carer’s assessment of severity, itch and sleep loss over the previous 3 days   Patient-Orientated Eczema Measure (POEM) Patient self-assessment for monitoring symptoms and disease severity   Children’s Dermatology Life Quality index (CDLQI) Impact of eczema on the child   Infants Dermatology Life Quality Index (CDLQI) Impact of eczema on the infant   Dermatitis Family Impact (DFI) questionnaire Impact of eczema on the child’s parents/carer

The patient-orientated eczema measure (POEM) is a useful tool for adults in self-assessing symptoms and disease severity in atopic eczema. Tools assessing the effects of quality of life for adults with eczema may include the Dermatology Life Quality Index and SCORAD. These assessment tools are discussed in more detail in Psychological and social aspects of skin care and Assessment and planning care respectively. There is a need for health professionals to adopt a holistic approach to eczema assess ment, taking into account of both the severity of atopic eczema, quality of life/everyday activities and psychosocial well-being. NICE (2007) recommends a simple holistic assessment tool outlined in Table 9.4.

Table 9.4 Holistic assessment for atopic eczema recommended by NICE (2007).   Skin/physical assessment    Impact on quality of life and psychosocial    well-being   CLEAR Normal skin, no evidence of atopic eczema   NONE No impact on quality of life   MILD Areas of dry skin, infrequent itching (with or without small areas of redness)   MILD Little impact on everyday activities, sleep and psychosocial well-being   MODERATE Areas of dry skin, frequent itching, redness (with or without excoriation and skin thickening)   MODERATE Moderate impact on everyday activities and psychosocial well-being, frequently disturbed sleep   SEVERE Widespread area of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation)   SEVERE Severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep