Rajka and Langeland developed a simple scoring system for grading the severity of atopic dermatitis. This can help separate patients into those with mild, moderate and severe disease activity. The authors are from Oslo, Norway.
Parameters for score:
(1) extent of involvement (as determined by the "rule of 9", as used for burn area)
(2) course
(3) intensity of disease, as determined by itch (considered by the authors to be the basic trait for atopic dermatitis)
Parameter
Finding
Points
extent
child and adult phase, < 9% of body area
1
child and adult phase, skin involved more than score 1 and less than score 3
2
child and adult phase, > 36% of body area involved
3
infantile phase, < 18% of skin involved
1
infantile phase, skin involved more than score 1 and less than score 3
2
infantile phase, > 54% of skin involved
3
course
> 3 months of remission during the year
1
< 3 months remission during the year
2
continuous course
3
intensity
mild itch, only exceptionally disturbing night's sleep
1
itch, evaluated to be more than score 1, less than score 3
2
severe itch, usually disturbing night's sleep
3
where:
• rule of 9 for body surface area: head 9%, arm 9%, leg 18%, front torso 9%, back torso 9%, perineum 1%
• A score of 1.5 can be used if uncertain as to score 1 or 2; a score of 2.5 can be used if in doubt as to whether score 2 or 3.
• The criteria for the disease course may be adjusted in infants or if grading is being done less than a year after onset.
severity score =
= SUM(points for the 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 9
Score
Grade
3 or 4
mild
4.5 to 7.5
moderate
8 to 9
severe
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