EXPERIENCES WITH THE SEVERITY SCORING OF ATOPIC-DERMATITIS IN A POPULATION OF GERMAN PRESCHOOL-CHILDREN

Severity scoring of atopic dermatitis (SCORAD) was introduced as a sta ndard tool but has not been used in a population-based epidemiological study: the objective of the present study was to determine the practi cability of this instrument in this set-ting. We assessed the distribu tion of the severity of atopic eczema in the community and investigate d differences between east and west Germany. A factor analysis was the n carried out to characterize the variables of this scoring system and to analyse possible relationships within them. A multicentre cross-se ctional study was carried out in fine east German and two west German locations in 1994: pre-school children (5-6 years old) were investigat ed and cases of atopic eczema identified by a dermatological examinati on. The SCORAD was used to determine the severity of atopic eczema and the results assessed using analysis of variance and principal compone nt analysis (varimax rotation). In all, 1511 (76.2%) of the children o riginally contacted participated and 11.3% were diagnosed with atopic eczema at the time of examination. The median severity score was 21.4 (interquartile range 13.5) and there was a tendency to higher scores i n west Germany for the mean overall score, the intensity score and the extent. 'Erythema' (1.30 vs, 1.06; P = 0.006) and 'excoriation' (0.77 vs, 0.36; P = 0.002) were significantly more prominent in children wi th eczema from west Germany (adjusted for observer). Interobserver var iabilities of the SCORAD parameters were calculated, adjusted for loca tion and were in accordance with earlier findings, Principal component analysis identified three independent factors accounting for 54.1% of the total variance. A severity factor characterized by 'extent', 'lic henification', 'excoriation' and 'pruritus', was separated from a fact or with an acute eczema-type profile ('erythema', 'oedema', 'oozing') and a factor whose major characteristics were 'extent', 'dryness', and 'sleep loss'. We conclude that atopic eczema is frequent in pre-schoo l children. The SCORAD proved to be readily applicable and useful in e pidemiological studies, but further validation is needed.