The SCORing Atopic Dermatitis (SCORAD) Index is a clinical tool used to assess the severity of atopic dermatitis (AD). Developed by the European Task Force on Atopic Dermatitis (ETFAD), it combines objective signs of AD, subjective symptoms, and the extent of affected areas to provide a comprehensive measure of disease severity. The SCORAD Index ranges from 0 to 103, with higher scores indicating more severe AD.

The problem that the SCORAD solves is that doctors don't have reliable diagnostic and activity markers for eczema. There is not a lab test that can practically be performed to measure the extent of the affectation of a patient. Therefore, eczema affectation can currently be measured only by the use of questionnaires, known as reported outcome measures, which are subjectively filled in.

Atopic dermatitis is a chronic inflammatory skin condition that significantly impacts patients' quality of life. Accurate assessment of disease severity is crucial for tailoring treatment plans, monitoring disease progression, and evaluating the efficacy of therapeutic interventions. The SCORAD Index offers a standardized method for quantifying disease severity, facilitating better patient management and comparability across clinical trials.

Eczema affects around 223 million people worldwide. Indeed, between 4% and 5% of the total population has eczema, of which around 43 million are aged 1 to 4 according to the International Eczema Council. Atopic dermatitis affects people's quality of life. It affects day-to-day activities and work productivity, and has negative effects on people's sleep, and emotional and psychological well-being. The burden of eczema on patients, their families and friends, the health care system and society is substantial.

When a doctor prescribes a treatment for a patient with eczema the severity of the disease is the most relevant data point to decide which is the correct treatment.

That is why doctors invented the SCORAD: it allows the measurement of the severity of eczema to prescribe the best treatment and to measure how it's working. Without a tool like SCORAD, it would be very difficult to help patients and develop new treatments for patients suffering from atopic dermatitis.

The formula to calculate the SCORAD is the following:

SCORAD = A / 5 + 7B / 2 + C

Where:

• A: Extent of affected area (scored 0-100 based on body surface area).
• B: Intensity score, which is the sum of six signs (erythema, edema/papulation, oozing/crusting, excoriation, lichenification, and dryness), each scored 0-3.
• C: Subjective symptoms (itch and sleeplessness), scored by the patient from 0-10 each, with a maximum of 20 points.

On this page, you will find the SCORAD Calculator as well as the advanced ASCORAD, an automatic SCORAD calculator by Legit.Health that provides fast and reliable results from patient images to assess atopic dermatitis severity.

The SCORAD Index is calculated by evaluating three main components:

1. Extent of Affected Areas:

• The body is divided into different regions, and the percentage of affected skin in each region is estimated.
• The extent score is calculated using the "Rule of Nines" to estimate the body surface area (BSA) involved.
• The total extent score ranges from 0 to 100.

2. Intensity of Clinical Signs:

• Six clinical signs are assessed: erythema (redness), edema/papulation (swelling), excoriation (scratch marks), lichenification (thickening), oozing/crusting, and dryness.
• Each sign is scored on a scale from 0 to 3:
• 0: None
• 1: Mild
• 2: Moderate
• 3: Severe
• The total intensity score ranges from 0 to 18.

3. Subjective Symptoms:

• Two subjective symptoms are evaluated: pruritus (itchiness) and sleep loss.
• Each symptom is scored on a visual analogue scale (VAS) from 0 to 10.
• The total subjective symptoms score ranges from 0 to 20.

Example SCORAD Calculation

For a patient with the following scores:

• Extent of affected areas: 30%
  • Erythema: 2
  • Edema/Papulation: 1
  • Excoriation: 2
  • Lichenification: 1
  • Oozing/Crusting: 1
  • Dryness: 2
• Subjective symptoms:
  • Pruritus: 8
  • Sleep loss: 5

The SCORAD score would be calculated as follows:

• Extent: 30
• Intensity: (2+1+2+1+1+2) = 9
• Subjective symptoms: (8+5) = 13

Total SCORAD score = Extent/5 + 7 * Intensity/2 + Subjective symptoms = 30/5 + 7 * 9/2 + 13 = 6 + 31.5 + 13 = 50.5

On this page, you will find the SCORAD Calculator as well as the ASCORAD, an innovative automatic SCORAD assessment tool by Legit.Health for precise image-based scoring of atopic dermatitis severity.

The SCORAD (Scoring Atopic Dermatitis) index is the most widely used tool for assessing atopic dermatitis (AD) severity, but it has notable limitations. It is widely used in both clinical and research settings because it considers multiple aspects of the condition, including:

• Extent of the disease: The percentage of the body affected by AD. Intensity of clinical signs: The severity of erythema, edema, excoriation, and lichenification.
• Subjective symptoms: Itching and sleep disturbance, which are key factors in the patient's experience of AD.

While SCORAD is effective, it has some limitations, such as:

• Subjectivity: The assessment of clinical signs and subjective symptoms can vary between different clinicians and patients.
• Complexity: The calculation process can be time-consuming and complex, requiring detailed assessments.
• Training Requirement: Consistent and accurate scoring requires proper training and experience.

In 2020, Legit.Health launched the Automatic SCORAD (ASCORAD), the first AI-driven tool designed to automatically measure the SCORAD index for atopic dermatitis. ASCORAD calculates how much atopic dermatitis a patient has by analyzing patient images with artificial intelligence, functioning as the automatic version of SCORAD. Through AI, ASCORAD generates precise SCORAD scores in real time.

ASCORAD's primary purpose is to deliver accurate and consistent assessments of atopic dermatitis severity for routine care and clinical studies. Its main advantage is speed: ASCORAD requires just seconds to provide results, compared to the several minutes typically needed for manual scoring. Additionally, ASCORAD reduces inter-observer variability, achieving a margin of error well below traditional methods, which often face inconsistencies.

ASCORAD represents a new era in dermatology, offering clinicians a reliable tool for assessing and tracking atopic dermatitis severity. This enables health professionals to practice evidence-based medicine with greater precision, improving both treatment outcomes and patient communication.

• Speed and Efficiency: Quick assessment through image analysis reduces the time needed for manual scoring.
• Consistency: Reduces inter-observer variability and potential human errors.
• Patient Adherence: Easier for patients to adhere to regular monitoring schedules.