IGA, BSA Product Proves a Simpler Alternative to EASI for Assessing Pediatric Atopic Dermatitis

Atopic dermatitis behind the knees
Atopic dermatitis behind the knees
Implementation of the IGA×BSA product for rapid, routine in-office assessment and monitoring of pediatric patients with atopic dermatitis is now recommended.

An Investigator Global Assessment (IGA) and body surface area product (IGA×BSA) using the validated IGA (vIGA) is a quick, simple, and easy-to-interpret alternative to the Eczema Area and Severity Index (EASI) for the assessment of atopic dermatitis (AD) severity in children, a study suggests. The findings from the study were published in the Journal of the American Academy of Dermatology.

A total of 195 caretaker/child dyads between the ages of 5 and 17 years were recruited from allergy and dermatology clinics at the Ann and Robert H. Lurie Children’s Hospital of Chicago (LCH) in Illinois and the 2018 National Eczema Association’s Eczema Expo in Chicago. For the study, the researchers collected patient-reported and objective disease severity measures using the vIGA, a recently validated tool with descriptors that standardize the assessed severity of erythema, induration/papulation, lichenification, and oozing/crusting at each severity grade. These grades include clear (vIGA=0), almost clear (vIGA=1), mild (vIGA=2), moderate (vIGA=3), and severe (vIGA=4).

The cohort consisted of 23.6% children with mild AD, 48.7% with moderate AD, and 27.7% with severe AD. Poorer quality of life, as assessed by the CDLQI, was associated with worsening disease severity in this population (CDLQI/DLQI vs IGA×BSA, r=0.354, P <.001). The IGA×BSA correlated more strongly with EASI than the vIGA alone (r=0.924 vs r=0.757; P <.001). Although there were significant correlations between the IGA×BSA and POEM (r=0.449, P <.001), average pruritus numeric rating scale (r=0.332, P <.001), and CDLQI (r=0.354, P <.001), these were not as strong.

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Proposed IGA×BSA severity strata with the highest kappa coefficient included 0 to 30 for mild, 30.1 to 130 for moderate, and 130.1 to 400 for severe (κ=.760, P <.001). According to the investigators, these strata demonstrate high agreement with accepted AD severity categories in EASI.

A study limitation included the lack of geographical diversity in regard to participant representation.

Based on this analysis, the researchers recommend the use of the IGA×BSA assessment and monitoring of children with AD in clinical practice, considering “justification of severity will likely be required for prescribing new therapeutic agents for moderate-to-severe disease.”


Suh TP, Ramachandran D, Patel V, et al. Product of Investigator Global Assessment and body surface area (IGAxBSA): a practice-friendly alternative to the Eczema Area and Severity Index (EASI) to assess atopic dermatitis severity in children [published online January 20, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.01.023