A new, modified version of the patient-oriented (PO) SCORing for Atopic Dermatitis (SCORAD) tool is as effective for evaluating atopic dermatitis (AD) in black skin as a previous version used in European countries for white skin, according to a validation study published in the European Academy of Dermatology and Venereology.
The study showed that results from a version of the PO-SCORAD designed especially for black skin correlated well to physician SCORAD assessments in 113 black patients recruited from sub-Saharan African countries. The patient base was 61.6% female, including 72 children and 41 adults from Benin, Burkina Faso, Cameroon, Ivory Coast, Gabon, Mali, and Senegal.
Some questions regarding clinical signs of AD used for the original PO-SCORAD tool were modified to address differences in presentation of the disease in black skin types compared with white skin types, particularly regarding erythema and lichenification. Other skin manifestations including skin thickening, edema, oozing or crusty skin, excoriations, and xerosis are similar in both black and white skin types, and were not readdressed.
For the purposes of the current validation study, total scores from both tools were used to determine severity levels as mild, moderate, or severe (<25, 25-49, and >50, respectively). The results showed a consistently high correlation between the PO and physician-based evaluations (0.67 in children and 0.64 in adults, using Spearman’s correlation coefficient; P <.0001) in total scores.
The subanalysis of individual symptom assessments, however, indicated greater disparity between patient/parent evaluations and the SCORAD from physicians. The patient/parent evaluations showed lower scoring for the intensity of symptoms of redness and swelling/papulation compared with physician scores, and higher ratings for scratch marks and skin thickening. Scoring from both PO and physician-based evaluations for dryness and oozing/scabbing were similar.
The study was limited by a small sample size and evaluation at a single time. Patient/parent participants could receive assistance in completing the questionnaires, and an independent reader was used to calculate their scores, which may not reflect real-world conditions.
Overall, the researchers found the correlations between patient/parent assessments and those of physicians to be high and on a par with the SCORAD tool previously evaluated in 12 European countries. On that basis, they consider the PO-SCORAD for black skin to be a valuable tool. They suggested that additional training for patients and parents in assessment of individual symptom intensity would improve the accuracy of the PO-SCORAD measurements.
Faye O, Meledie N’Djong AP, Diadie S, et al. Validation of the patient-oriented SCORing for atopic dermatitis (PO-SCORAD) for black skin [published online October 6, 2018]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15999