_id

683a164cc782e11e38d1b324

id

10427

complaint

[ "Rash" ]

departments

[ "Allergic", "Dermatologic", "Immunologic" ]

description

The Eczema Area and Severity Index (EASI) stratifies severity of eczema.

diseases

[ "Eczema" ]

evidence

• The Eczema Area and Severity Index (EASI) was first described in 1998 by Tofte et al. In 2001, Hanifin et al presented the assessment of reliability of EASI in atopic dermatitis (AD). This assessment was performed over 2 successive days on 15 dermatologist evaluators. EASI was found to have fair-to-good overall intra-evaluator reliability and good inter-evaluator reliability. EASI was considered an easily understood and simple tool for the evaluation of AD. 
• More studies were later done to further validate EASI. Barbier et al in 2004 looked at the use of EASI for atopic dermatitis in a cohort of 1,550 patients in RCTs of 1% pimecrolimus cream. EASI showed good criterion and construct validity, reliability, and sensitivity to change, and correlated well with other measures of disease severity and pruritus assessment. Internal consistency was good in all components except for lichenification. EASI, however, did not correlate well with quality of life.
• In 2007, a systematic review on outcome measures of AD by Schmitt et al found that EASI has adequate convergent and divergent construct validity, adequate sensitivity to change and adequate content validity. Based on the criteria in this study, test-retest reliability, interobserver reliability and internal consistency were considered acceptable.
• In 2013 Schmitt et al performed a systematic review on measurement properties of outcome measurements for clinical signs of atopic dermatitis. EASI is valid and internally consistent and has adequate intraobserver reliability, intermediate interobserver reliability and adequate responsiveness. Despite this, EASI has its drawbacks, including lack of interpretability (definition of ranges of EASI that represent mild, moderate and severe) and the absence of floor or ceiling effect.
• To improve interpretability of EASI, Lesham et al suggested severity strata, later revised by Chopra et al in 2017: 0 = clear; 1-5.9 = mild; 6-22.9 = moderate; 23-72 = severe.
• One of the pitfalls in most AD severity scales (including EASI) is its reliability in patients with dark skin. In 2015, Zhao et al studied the reliability and validity of outcome measures in patients with different levels of skin pigmentation. Overall, outcome measures including EASI have poor reliability and validity in patients with dark skin. To date, there is no specific outcome measure for this cohort of patients.

formula

Total EASI = addition of EASI for each body region (i.e., head/neck, upper limbs, trunk, and lower limbs) EASI for each body region = severity score x area score x multiplier The severity score is calculated by the addition of the selected points: The area score is determined as follows: The multiplier is determined as follows:

full_title

Eczema Area and Severity Index (EASI)

information

Interpretation:

A higher EASI score indicates higher severity of atopic dermatitis. Scores range from 0 (no disease) to 72 (maximal disease severity).

input_schema

[ { "subheading": "Head/neck", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "<p>Redness</p>", "name": "h1", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Erythema, inflammation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Thickness</p>", "name": "h2", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Induration, papulation, swelling; acute eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Scratching</p>", "name": "h3", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Excoriation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Lichenification</p>", "name": "h4", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Lined skin, furrowing, prurigo nodule; chronic eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Percentage of region affected</p>", "name": "hp", "optional": false, "options": [ { "label": "0% (no active eczema in region)", "value": 0 }, { "label": "1-9%", "value": 1 }, { "label": "10-29%", "value": 2 }, { "label": "30-49%", "value": 3 }, { "label": "50-69%", "value": 4 }, { "label": "70-89%", "value": 5 }, { "label": "90-100% (entire region affected by eczema)", "value": 6 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "subheading": "Upper limbs", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "<p>Redness</p>", "name": "u1", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Erythema, inflammation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Thickness</p>", "name": "u2", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Induration, papulation, swelling; acute eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Scratching</p>", "name": "u3", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Excoriation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Lichenification</p>", "name": "u4", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Lined skin, furrowing, prurigo nodule; chronic eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Percentage of region affected</p>", "name": "up", "optional": false, "options": [ { "label": "0% (no active eczema in region)", "value": 0 }, { "label": "1-9%", "value": 1 }, { "label": "10-29%", "value": 2 }, { "label": "30-49%", "value": 3 }, { "label": "50-69%", "value": 4 }, { "label": "70-89%", "value": 5 }, { "label": "90-100% (entire region affected by eczema)", "value": 6 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "subheading": "Trunk", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "<p>Redness</p>", "name": "t1", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Erythema, inflammation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Thickness</p>", "name": "t2", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Induration, papulation, swelling; acute eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Scratching</p>", "name": "t3", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Excoriation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Lichenification</p>", "name": "t4", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Lined skin, furrowing, prurigo nodule; chronic eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Percentage of region affected</p>", "name": "tp", "optional": false, "options": [ { "label": "0% (no active eczema in region)", "value": 0 }, { "label": "1-9%", "value": 1 }, { "label": "10-29%", "value": 2 }, { "label": "30-49%", "value": 3 }, { "label": "50-69%", "value": 4 }, { "label": "70-89%", "value": 5 }, { "label": "90-100% (entire region affected by eczema)", "value": 6 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "subheading": "Lower limbs", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "<p>Redness</p>", "name": "l1", "optional": false, "options": [ { "label": "None. absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Erythema, inflammation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Thickness</p>", "name": "l2", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Induration, papulation, swelling; acute eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Scratching</p>", "name": "l3", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Excoriation", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Lichenification</p>", "name": "l4", "optional": false, "options": [ { "label": "None, absent", "value": 0 }, { "label": "Mild (just perceptible)", "value": 1 }, { "label": "Moderate (obvious)", "value": 2 }, { "label": "Severe", "value": 3 } ], "show_points": true, "tips_en": "Lined skin, furrowing, prurigo nodule; chronic eczema", "type": "radio" }, { "conditionality": null, "default": null, "label_en": "<p>Percentage of region affected</p>", "name": "lp", "optional": false, "options": [ { "label": "0% (no active eczema in region)", "value": 0 }, { "label": "1-9%", "value": 1 }, { "label": "10-29%", "value": 2 }, { "label": "30-49%", "value": 3 }, { "label": "50-69%", "value": 4 }, { "label": "70-89%", "value": 5 }, { "label": "90-100% (entire region affected by eczema)", "value": 6 } ], "show_points": true, "tips_en": "", "type": "radio" } ]

instructions

Use in patients >8 years old with atopic dermatitis.

ismed

false

keywords

Easi, eczema, eczema severity, Eczema Area and Severity Index, PASI, psoriasis, psoriasis severity index, Eczema Area Severity Index (EASI), eczema index, eczema area, eczema severity index, eczema area index, atopic dermatitis, atopic dermatitis severity index, atopic dermatitis severity

measurements

[]

med_description

Stratifies severity of eczema.

next_actions

Consultation with a dermatologist may be warranted in patients with atopic dermatitis.

next_advice

• The higher the EASI score, the higher the severity of atopic dermatitis. 

• Recording the trend of EASI score helps with assessing the effectiveness of a treatment.

next_management

pearls

• EASI is one of the most widely used instruments in assessing atopic dermatitis in both clinical and trial settings. 

• EASI is less reliable when assessing patients with darker skin.

published

purpose

[ "Diagnosis" ]

reasons

Easily understood and simple system used to track disease progression. May be used in pediatric patients. Used in clinical trials of therapies for atopic dermatitis. In Australia, EASI is used to determine eligibility for government subsidized prescription drugs.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.scienceopen.com/document?vid=03a4dc8d-2669-456f-94a8-a1f826f70615", "text": "Tofte SJ, Graeber M, Cherill R, Ornoto M, Thurston M, Hanifin JM. Eczema area and severity Index (EASI): A new tool to evaluate atopic dermatitis. Journal of the European Academy of Dermatology and Venereology. 1998; 11: S197." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/28485036", "text": "Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu DY, Silverberg JI. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. British Journal of Dermatology. 2017; 117: 1158-1159." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/28494438", "text": "Bozek A, Reich AN. Assessment of Intra- and Inter-rater reliability of three methods for measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA. Dermatology 2017; 233: 16-22." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25580670", "text": "Leshem YA, Hajar T, Hanifin JM, Simpson EL. What the Eczema Area and Severity Index Score tells us about the severity of atopic dermatitis: an interpretability study. British Journal of Dermatology 2015: 172; 1353-1357." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418878/", "text": "Zhao CY, Wijayanti A Doria MC, Harris AG, Jain SV, Legaspi KN, Dlova NC, Law MG, Murrell DF. The reliability and validity of outcome measures for atopic dermatitis in patients with pigmented skin: A grey area. International Journal of Women’s Dermatology 2015: 150-154." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/24035157", "text": "Schmitt J, Langan S, Deckert S, Svensson A, Kobyletzki LV, Thomas K, Spuls P. Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation. J Allergy Clin Immunol. 2013; 132 (6): 1337 – 1347." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21951293", "text": "Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimally clinically important difference. Allergy 2012; 67:99-106." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21533286", "text": "Rehal B, Armstrong A. Health Outcome Measures in Atopic Dermatitis: A systematic review of Trends in Disease Severity and Quality of Life Instruments 1985 - 2010. Plos One. 2011; 6(4); e17520." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/17910890", "text": "Schmitt J, Langan S, Williams HC. What are the best outcome measurements. J Allergy Clin Immunol 2007: 120 (6): 1389-1398. " }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/?term=25282560", "text": "Schmitt J, Spuls P, Thomas KS, Simpson E, Furue M. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. Journal of Allergy and Clinical Immunology 2014: 134(4):800-7. " } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/11168575", "text": "Hanifin JM, Thurston M, Ornoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. Exp Dermatol 2001: 10: 11-18. " }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/14746622", "text": "Barbier N, Paul C, Luger T, et al. Validation of the Eczema Area and Severity Index for atopic dermatitis in a cohort of 1550 patients from the pimecrolimus cream 1% randomized controlled clinical trials programme. Br J Dermatol. 2004;150(1):96-102." } ], "Validations": [] }

related

[ { "calcId": 10568, "short_title_en": "Rule of Nines", "slug": "rule-nines" }, { "calcId": 10235, "short_title_en": "Truelove/Witts Severity Index for UC", "slug": "truelove-witts-severity-index-ulcerative-colitis" }, { "calcId": 10497, "short_title_en": "I-SEE", "slug": "index-severity-eosinophilic-esophagitis-i-see" } ]

search_terms

[ "Eczema Area and Severity Index (EASI)", "Easi", "eczema", "eczema severity", "Eczema Area and Severity Index", "eczema index", "eczema area", "eczema severity index", "eczema area index", "atopic dermatitis", "atopic dermatitis severity index", "atopic dermatitis severity" ]

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

seo

{ "keywords_en": "Easi, eczema, eczema severity, Eczema Area and Severity Index, PASI, psoriasis, psoriasis severity index, Eczema Area Severity Index (EASI), eczema index, eczema area, eczema severity index, eczema area index, atopic dermatitis, atopic dermatitis severity index, atopic dermatitis severity", "meta_description_en": "The Eczema Area and Severity Index (EASI) stratifies severity of eczema." }

short_description

Eczema severity.

short_title

Eczema Area and Severity Index (EASI)

slug

eczema-area-severity-index-easi

specialty

[ "Allergy and Immunology", "Dermatology", "Hospitalist Medicine", "Internal Medicine" ]

tags

[]

title

Eczema Area and Severity Index (EASI)

usecase

Patients >8 years old with atopic dermatitis, to assess severity and extent.

version_number

versions

[]

cleaned_departments

[ "immunology", "dermatology", "immunology" ]

cleaned_use

[ "Patients >8 years old with atopic dermatitis, to assess severity and extent." ]

pub

false