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Severity scoring of atopic dermatitis: The scorad index
Poster Presentations
489 SEVERITY
492 SCORING
OF ATOPIC
DERdATITIS:
THE SCORAD
The assessment methods of atopx dermatitis (AD) are not standardized and thcrapeuuc studies are often difficult to interpret Effons have been done recently 10 classify palien& in groups of seventy and 10 establish simple and reliable assessment melhods. The aims of the European Task Force on Ampic Dermatitis were to provide a toal 10 record data precisely and consistently for routine evaluations and clinical studies at various instillllions and 10 develop a composite scoring index for AD. Consensus definmons were gwen for six iolensity items: (I) eryxhema, (2) e&ma/papulatioo. (3) aozinglcrusts. (4) excoriations. (5) licheoification and (6) dryness. Each item is graded from O-3 (O=absenl.I=mdd. Z=moderatc. 3=severe) according 10 reference photographs 7he area chosen for grading rnus~ be representative (average intensity) for each item in a given patiem as determined by Ihe investigafor. thus excluding one ‘target’ area or the worst affected site. Dryness must be appreciated on areas not rnvolved by acme lesions or lichenifications. The SCORAD (score of AD) combines the grading of Ihe exlenl (using the rule of nine for body surfaa involved witi regard to Lhe age of Ihe patient). swcmyfinwnsity of Ihe skin lesions and subjective symploms (average value of pmnlus and sleep loss for the last 3 days/nigh& indicaad on a 10 cm visual analog scale by ule paoent). Rle SCORAD is simple and easy to uy in outpatient clinics. Based on mathemadcal appreciation of weights of the items used in the assessment of AD, extent and sub,ecdve symptoms accounf for around 20% each of the total score. imensny items representing 60%. The so-designedcompositeindex SCORAD needs to be funher tested in clinical oials.
490 INDOOR ATOPIC
493 AIR POLLUTION ECZEMAIPA~IENTL-
AND
RLLERGEN Barbara
EXPPSURE Kunz , Yves
IN
HOMES
9F
de ,Prosf , UIIl"erSlty Department of Dermatology, Johannes Rinq University of Hamburg, Germany and Ejospitpl Eppendbrf, Hopltal Necker Enfants Malades, University of Paris,
increasing role Of I” face of evidence *or a environmental factors in the pathophysioloqy of atopic performed a case-control study in 57 eczema (AE), AE patients (age 4x11- 9y) cad I68 controls (age 8" - 10~). sensitization Specific common allergens was determined by prick test and RAST in all patients. The childrens' domestic environment was monitored by means of passive samplers for airborn S02, NOX and formaldehyde (FA) and evaluation of house dust mite allergen levels The concentrations (Der PI and Der Fl, ELISA technique). in Parisian homes were of SO*, NOX and formaldehyde (502);20,8 (NOx);7,0 (FA) [ug/m3],medians). differences in exposure levels bet,ween atopic and control bedrooms. Der PI found childrens' atopics'fmedian 160 nq/g dust) a:: 60% Of czkrols'(199 significant differences between rig/g dust, homes, without the two groups. Atopic children having specific serum IgE to D. pter. were exposed to significantly higher levels slgE of Der PI (2509 nq,q d";;',,,';;" were those w,tho;t dust). study show The does (:5On9/g differences in indo,or, environment between atopic patienfs and controls. Spe;;;;;e~ouse dust mite sensltlzatlon III to house allergen AE patients is dust mite exposure levels.
we have
There wer~‘~~ 80% of
491 ~~N~~RDAN~E
494 0~ *TOPY
PATCH n5.s~. PRANK TEST AND spEcmc
ICE IN
PATIENTS WlTH ATOPIC ECZEMA. “If Dxsow. Dieter Vi&f and Johannes Rim?, Depanmenr of Da-matology/AUergology. Univemity of Hamburg, Hamburg. FRG In a subgroup of patients wbh ample eczema (AE) eczematow skin lesiau cao be induced by epicuraneous testing with aeroallergeos (Afopy Patch Tea, APT). Previous studies revealed lnl&dividual differences io reactiviry to APTprick teSt and amouot of spwbic se_-IgE to the auergeos rested. We performed a standardized APT I” 53 padems with moderate (D severe AE. Patients were wsted epicutaneously on non-abraded. uninvolved back skin wilh allergens of house dust mire (D.pler.), car dander and grass pollen in a coocenvation of IO.ooO PN”,g (vehicle: peuOla”,m). Reactions were evaluated after48 hrs. In order to cornlate the classic diagnostic parameters of IgE-related allergy with the APT. prick an and detemunation of total and specific IgE to fhe 3 allergens have been performed. “eear-cut positive API-resulm wele compared 10 Lhe mdividual prick test and RAST-resulti (CAP-flass >I). 23 of 53 padeols wkb AE showed at leaa one clear-cut @live AFT wacoon. 14 of them had a rota! IgE > ,,ooO “,I. 87% of these 23 paieots WCIF. found 1o be reacdve 10 D.pter., 61% to cm dander and 35% to grass poUeo. h 75% of patienrs presenting positive AFT to D.per.. a correspoodiog positive prick test (ca: 93%. grass pollen: 63%) and no 80% of them a conespoodmg RAST (cat: 71%. grass pollen: 75%) could be observed. I5 of 34 (16 of 30) padems witi a D.prer.-positive prick lest (RAST) showed a corresponding posbive APT-resuh, but also 5 of 19 (4 of 23) prick-negative (RAST-negnive) patients developed clear-cut eczanatous AFT reactions wi* tis allergen. The resulu show ulat p&live imracumoeous tes& and raised allergen-spaxfic IgE are mx mandatory for a positive AFT. It can be concluded that rhe APT may give hrnkr diagnostic information in addition to the established cesI procedures to elucidxe Ihe relevance of aemdfergeos eliciting eczematow skin lesions in a subgroup of patients wiIh AE
489 SEVERITY
492 SCORING
OF ATOPIC
DERdATITIS:
THE SCORAD
The assessment methods of atopx dermatitis (AD) are not standardized and thcrapeuuc studies are often difficult to interpret Effons have been done recently 10 classify palien& in groups of seventy and 10 establish simple and reliable assessment melhods. The aims of the European Task Force on Ampic Dermatitis were to provide a toal 10 record data precisely and consistently for routine evaluations and clinical studies at various instillllions and 10 develop a composite scoring index for AD. Consensus definmons were gwen for six iolensity items: (I) eryxhema, (2) e&ma/papulatioo. (3) aozinglcrusts. (4) excoriations. (5) licheoification and (6) dryness. Each item is graded from O-3 (O=absenl.I=mdd. Z=moderatc. 3=severe) according 10 reference photographs 7he area chosen for grading rnus~ be representative (average intensity) for each item in a given patiem as determined by Ihe investigafor. thus excluding one ‘target’ area or the worst affected site. Dryness must be appreciated on areas not rnvolved by acme lesions or lichenifications. The SCORAD (score of AD) combines the grading of Ihe exlenl (using the rule of nine for body surfaa involved witi regard to Lhe age of Ihe patient). swcmyfinwnsity of Ihe skin lesions and subjective symploms (average value of pmnlus and sleep loss for the last 3 days/nigh& indicaad on a 10 cm visual analog scale by ule paoent). Rle SCORAD is simple and easy to uy in outpatient clinics. Based on mathemadcal appreciation of weights of the items used in the assessment of AD, extent and sub,ecdve symptoms accounf for around 20% each of the total score. imensny items representing 60%. The so-designedcompositeindex SCORAD needs to be funher tested in clinical oials.
490 INDOOR ATOPIC
493 AIR POLLUTION ECZEMAIPA~IENTL-
AND
RLLERGEN Barbara
EXPPSURE Kunz , Yves
IN
HOMES
9F
de ,Prosf , UIIl"erSlty Department of Dermatology, Johannes Rinq University of Hamburg, Germany and Ejospitpl Eppendbrf, Hopltal Necker Enfants Malades, University of Paris,
increasing role Of I” face of evidence *or a environmental factors in the pathophysioloqy of atopic performed a case-control study in 57 eczema (AE), AE patients (age 4x11- 9y) cad I68 controls (age 8" - 10~). sensitization Specific common allergens was determined by prick test and RAST in all patients. The childrens' domestic environment was monitored by means of passive samplers for airborn S02, NOX and formaldehyde (FA) and evaluation of house dust mite allergen levels The concentrations (Der PI and Der Fl, ELISA technique). in Parisian homes were of SO*, NOX and formaldehyde (502);20,8 (NOx);7,0 (FA) [ug/m3],medians). differences in exposure levels bet,ween atopic and control bedrooms. Der PI found childrens' atopics'fmedian 160 nq/g dust) a:: 60% Of czkrols'(199 significant differences between rig/g dust, homes, without the two groups. Atopic children having specific serum IgE to D. pter. were exposed to significantly higher levels slgE of Der PI (2509 nq,q d";;',,,';;" were those w,tho;t dust). study show The does (:5On9/g differences in indo,or, environment between atopic patienfs and controls. Spe;;;;;e~ouse dust mite sensltlzatlon III to house allergen AE patients is dust mite exposure levels.
we have
There wer~‘~~ 80% of
491 ~~N~~RDAN~E
494 0~ *TOPY
PATCH n5.s~. PRANK TEST AND spEcmc
ICE IN
PATIENTS WlTH ATOPIC ECZEMA. “If Dxsow. Dieter Vi&f and Johannes Rim?, Depanmenr of Da-matology/AUergology. Univemity of Hamburg, Hamburg. FRG In a subgroup of patients wbh ample eczema (AE) eczematow skin lesiau cao be induced by epicuraneous testing with aeroallergeos (Afopy Patch Tea, APT). Previous studies revealed lnl&dividual differences io reactiviry to APTprick teSt and amouot of spwbic se_-IgE to the auergeos rested. We performed a standardized APT I” 53 padems with moderate (D severe AE. Patients were wsted epicutaneously on non-abraded. uninvolved back skin wilh allergens of house dust mire (D.pler.), car dander and grass pollen in a coocenvation of IO.ooO PN”,g (vehicle: peuOla”,m). Reactions were evaluated after48 hrs. In order to cornlate the classic diagnostic parameters of IgE-related allergy with the APT. prick an and detemunation of total and specific IgE to fhe 3 allergens have been performed. “eear-cut positive API-resulm wele compared 10 Lhe mdividual prick test and RAST-resulti (CAP-flass >I). 23 of 53 padeols wkb AE showed at leaa one clear-cut @live AFT wacoon. 14 of them had a rota! IgE > ,,ooO “,I. 87% of these 23 paieots WCIF. found 1o be reacdve 10 D.pter., 61% to cm dander and 35% to grass poUeo. h 75% of patienrs presenting positive AFT to D.per.. a correspoodiog positive prick test (ca: 93%. grass pollen: 63%) and no 80% of them a conespoodmg RAST (cat: 71%. grass pollen: 75%) could be observed. I5 of 34 (16 of 30) padems witi a D.prer.-positive prick lest (RAST) showed a corresponding posbive APT-resuh, but also 5 of 19 (4 of 23) prick-negative (RAST-negnive) patients developed clear-cut eczanatous AFT reactions wi* tis allergen. The resulu show ulat p&live imracumoeous tes& and raised allergen-spaxfic IgE are mx mandatory for a positive AFT. It can be concluded that rhe APT may give hrnkr diagnostic information in addition to the established cesI procedures to elucidxe Ihe relevance of aemdfergeos eliciting eczematow skin lesions in a subgroup of patients wiIh AE