Scoring the severity of atopic dermatitis: Three item severity score as a rough system for daily practice and as a pre-screening tool for studies

Different scoring systems have been developed to determine the severity of atopic dermatitis. The SCORAD (SCORing Atopic Dermatitis), one of the best validated systems, is suited for clinical trials, but is too complicated an d time consuming for routine clinical use. The TIS score (Three Item Severi ty score), a simplified system, is based on the evaluation of erythema, oed ema/papulation and excoriation on a scale from 0 to 3. In order to determin e the value of the TIS score we conducted a prospective study in 126 childr en with mild to severe atopic dermatitis. Both the TIS score and the SCORAD mere assessed by trained investigators. Interobserver agreement was invest igated in 20 children by comparing the independently performed scores of th ree investigators. A positive correlation was found between the TIS score a nd the SCORAD (Rank Spearman r(s) = 0.86; p < 0.0005). The item which corre lated best with the SCORAD was excoriation (r(s) = 0.72; p < 0.0005) follow ed by oedema/papulations (r(s) = 0.66; p < 0.0005), Interobserver agreement which was calculated by Cohen's kappa (kappa) was "excellent" for SCORAD ( kappa = 0.82; p < 0.001) and "fair" for TIS score (kappa = 0.58; p < 0.01), We conclude that the TIS score is a rough, though reliable and simple syst em for scoring atopic dermatitis. It is particularly suitable in general pr actice, for routine clinical use and for screening purposes in clinical tri als. For research purposes, the objective SCORAD offers a more detailed and comprehensive assessment.