New Consensus Recommendations for Atopic Dermatitis Control, Itch Intensity Tools

Evidence-informed recommendations reflecting consensus among clinicians, methodologists, patients, and industry representatives for measuring key domains for patients with atopic eczema (AE), or atopic dermatitis, in clinical practice include measuring eczema control using the Recap of Atopic Eczema (RECAP) and the Atopic Dermatitis Control Tool (ADCT). Recommendations also include measuring itch intensity using the Patient-Reported Outcomes Measurement Information System (PROMIS) 1-week peak, the PROMIS 1-week average numeric rating scale (NRS), and the 24-hour peak NRS. These are among the systematic review findings published in the Journal of the American Medical Association Dermatology.

Although the Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were consensus recommended in clinical practice to measure symptoms of atopic dermatitis, investigators believe a need exists for instruments to measure eczema control and itch intensity. They sought to recommend instruments to measure itch intensity and eczema control in clinical practice in patients with atopic dermatitis.

They conducted a systematic review of a consensus process held during the HOME VIII virtual online meeting October 6 to 9, 2020. Instrument selection for clinical practice was optimized by highlighting feasibility aspects. If fewer than 30% of voters disagreed, instrument consensus was reached.

Recommended instruments to measure eczema control were the RECAP and ADCT (5% and 10% of voters disagreed, respectively) from 7 identified instruments that were considered. They found the Patient Global Assessment, Impact of Chronic Skin Disease on Daily Life, Atopic Eczema Score of Emotional Consequences, Patient Benefit Index, and Atopic Dermatitis Score 7 may all have potential but required additional validation studies.

Among the 6 identified itch-intensity instruments considered, 3 from the PROMIS itch questionnaire found consensus recommendation: peak 24-hour NRS-itch, 1-week average NRS-itch, and 1-week peak NRS-itch instruments (17%, 22%, and 27% voters disagreed, respectively). Investigators observed among the other instruments considered, 24-hour average itch intensity did not have potential and additional validation studies were not necessary.

Review limitations include the that majority of meeting attendants were from Europe and North America therefore limiting generalizability, and newer instruments were not available at the meeting.

Investigators concluded their process “resulted in evidence-informed recommendations that reflect consensus among a group of patients, clinicians, methodologists, and industry representatives with an interest in AE for measuring 2 key domains for patients with AE in clinical practice: measuring eczema control using the RECAP and the ADCT; and measuring itch intensity using the 24-hour peak NRS, the PROMIS 1-week peak, and the PROMIS 1-week average NRS.”

Researchers anticipate use of these instruments to supplement, not replace, the medical encounter. They added, “The instrument a clinician chooses, and how to use it, depends on the domain and the objectives of the measurement, which can vary from patient baseline assessments and monitoring to quality improvement and real-world evidence generation.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.