SCORAD Calculator - SCORing Atopic Dermatitis

Created by Aleksandra Zając, MD
Reviewed by Dominik Czernia, PhD candidate and Jack Bowater
Last updated: Feb 15, 2022

The SCORing Atopic Dermatitis (SCORAD) calculator helps you assess the severity of eczema in your patient or anyone in need. And, if you're new to the topic, you will definitely find it helpful to learn what atopic dermatitis is. You might also be surprised to find out that there are over 20 eczema scoring tools described!

You can choose the tool that best meets you and your patients' needs. Just bear in mind that the SCORing Atopic Dermatitis SCORAD calculator will always have your back!

What is atopic dermatitis?

Atopic dermatitis is a chronic, allergy-based skin condition that makes the skin extremely vulnerable to particular external factors. This condition means that the primary function of the skin, i.e., covering our whole body and protecting from the external environment, is impaired. The skin still offers some protection, but the irritants' penetration into the skin is facilitated. Transepidermal water loss (TEWL) is also possible. TEWL means that the water in your skin evaporates, leading to dry skin and potentially dehydration. When using a moisturizer, you try to minimize transepidermal water loss.

Increased TEWL and the ease with which the skin is irritated make the surface of your dermis reddened, dry, itchy, and even crusty. Over time, these lesions can make the skin thick, which is called lichenification, after which eczema and a rash can appear. If the lesions get infected, you can experience oozing and crusting.

What can trigger the skin to flare up like this? The cause varies from individual to individual, and can be, well, anything: wool, certain foods - common are milk or eggs, cosmetics, animals' fur, cold weather, dry air, damp air, pollen, hormonal changes, and even stress and sweat.

Treating atopic dermatitis effectively is crucial. The disease might not be that deadly itself, but it can be burdensome to the person affected and cause significant anxiety and even depression. Our SCORAD eczema calculator helps to assess the severity of this disease.

How to use the SCORing Atopic Dermatitis SCORAD calculator?

This atopic dermatitis severity scale is intended for use by clinicians, which must perform an objective assessment. Follow these steps to use the SCORAD calculator:

  1. The calculator is relatively long, so you will have to scroll down to see it in its entirety.
  2. First, the section is about the placement of the lesions. Our estimation of body area size is rough and comes from the famous rule of nines, but you've got some more precise values in the help texts. Hover over each body region to see those values.
  3. In the next section of the SCORAD calculator, assess the severity of the patient's symptoms. The scale goes from none to severe, with two levels in between - mild, and moderate.
  4. The last section is for the patient to report symptoms from the previous three days. Using a scale of 0-10, let them choose the severity of the symptoms they experience.
  5. Finally, you've got the SCORAD eczema calculator result. Overall, the higher the result, the more severe the condition is at the present time. The maximum result is 103.

The results are divided into three severity groups, as shown in the table below:

Score

Severity

⩽25

mild

26-50

moderate

>50

severe

Atopic dermatitis causes

Nowadays, atopic dermatitis causes are believed to be genetic. The disease runs in families, which supports the thesis. It is also connected to conditions like asthma, allergies and hay fever. Also, research shows that people with eczema have a defect in a gene coding for filaggrin. Filaggrin is a protein that joins the epidermal cells together, creating a barrier between us and the outside world.

When filaggrin isn't built correctly, it can't maintain our skin's barrier. The irritants and allergens, or just plain water, can penetrate deeper and cause inflammation. Every person's irritants are different, but there are a few things that will irritate almost every person with atopic dermatitis: wool, drying agents (think of hand sanitizers), damp conditions (manual dishwashing - always with gloves on!), aggressive soap, and stress.

Eczema treatment

Currently, eczema is considered chronic, and there is no cure. However, there are many ways to alleviate the symptoms.

To start with ourselves, self-care is the key. Abstaining from scratching, wearing non-irritant clothes, and avoiding triggers will help. The next thing is everyday skincare. For atopic dermatitis patients, moisturizing and occlusive emollients are a must - especially after a shower when your skin is prone to drying. You might even want to buy a humidifier for home use.

There is some evidence that omega-3 fatty acids and vitamin D supplementation can alleviate the symptoms of eczema.

Moving on to medical treatments, there are antihistamines (to give you relief from scratching) and anti-inflammatory drugs, like topical steroids or calcineurin inhibitors (CNI). In the most severe cases of eczema, you can use a biological or light treatment.

More atopic dermatitis severity scales and eczema scoring tools

Atopic dermatitis is a fairly common disease - data suggests that 7.3% of Americans have this condition. In the world, the number of people suffering from eczema is estimated to be ~800 million people. Since eczema is a very heterogeneous disease, not all patients have the same needs. So, it is not a surprise that SCORing Atopic Dermatitis (SCORAD) scale is not the only medical scale available - there are over twenty other ones described so far!

The other eczema scoring tools include:

  1. EASI (Eczema Area and Severity Index) - In comparison with SCORAD, it doesn't take into account the patient's symptoms.
  2. vIGA-AD (Validated Investigator Global Assessment scale for Atopic Dermatitis) - It is the simplest one, using only five degrees of the lesion severity. It doesn't care about the size of the affected area.
  3. SASSAD (Six Area Six Signs Atopic Dermatitis) - Assesses, as the name says, six signs in the six body areas. The maximum score is 108.
  4. POEM (Patient-Oriented Eczema Measure) - Asks only about the patient's opinions on their symptoms.
  5. TIS (Three Item Severity) - A simplified version of the SCORAD eczema scale, correlates well with the original one while taking much less time.
  6. ADAS (Atopic Dermatitis Antecubital Severity) - This one is the shortest scale so far because it assesses the severity of eczema based on only one antecubital fossa.

In everyday practice, physicians choose the scale that best suits their patients and the time they have available to them. But, for the purpose of clinical trials, one unified scoring system is preferred. That's why the HOME - Harmonizing Outcome Measures for Eczema - workgroup was convened. This only proves how complex and diverse this disease is!

FAQ

Can stress cause atopic dermatitis?

Yes, stress can cause atopic dermatitis flare-ups. The mechanism of the body reacting to stress includes cortisol production. Cortisol is called ‘a stress hormone’ and, as one of its multiple functions, regulates the way our immune system functions.

Low cortisol peaks are necessary, but if we stress too much, it eventually affects our immune response. It promotes inflammation, which makes our skin more prone to flare-ups and can worsen eczema symptoms.

How long do I wait for eczema scars to fade?

Eczema scars usually fade over time, but the period is pretty long - we’re talking months or years. Where a scar is already present, do your best to help your skin heal. Use a good emollient, don’t scratch or irritate the skin. Protect the lesion from the sun - cover it from sunlight and use a high-SPF sunscreen, as sun rays can make your scar darken.

How much vitamin D should I take for eczema?

To alleviate your eczema symptoms, you should take a regular dose based on your age, weight, height, and health status. Overall, the minimal daily dose for adults is 600 IU, but you might need even 2000 IU.

If you want to do higher doses, see your physician and do a blood test first.

How do I know my eczema is severe?

To know if your eczema is severe:

  1. Check an online SCORAD calculator.
  2. If you have 51 or more points on a SCORing Atopic Dermatitis SCORAD index, you know your eczema is severe.
  3. The more points you get, the more severe your atopic dermatitis is.
Aleksandra Zając, MD
SCORing Atopic Dermatitis - SCORAD - This scale helps you evaluate atopic dermatitis. Input an estimate of the affected area, then assess the clinical signs and ask the patient about his subjective symptoms.
Affected area
Head and neck
%
Upper extremities
%
Anterior trunk
%
Back
%
Lower limbs
%
Genitals
%
Clinical signs intensity
Redness
None
Dryness
None
Oozing
None
Thickening
None
Swelling
None
Scratch marks
None
Subjective symptoms intensity - last three days
Pruritus
None
Insomnia
None
Result
The SCORAD result is 0 points. This suggests a mild form of atopic dermatitis.
SCORAD results range from 0 to 103 - the bigger the result, the more severe the disease.
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