SCORING OF ATOPIC-DERMATITIS BY SCORAD USING A TRAINING ATLAS BY INVESTIGATORS FROM DIFFERENT DISCIPLINES

The ETAC (Early Treatment of the Atopic Child) study, a multi-national double-blind placebo-controlled randomized trial, has been in progres s since 1994. Fifty-six centers in Europe and Canada participate in th is study, A total of 817 children with atopic dermatitis [AD] were rec ruited. The severity of AD was scored using the SCORAD (objective crit eria). Ninety-eight investigators (mostly pediatricians) were trained by three members of the European Task Force on Atopic Dermatitis [ETFA D] to standardize their objective SCORAD scoring (system developed by the ETFAD). The experts selected photographs and prepared a training a tlas. The percentages of photographs assessed by the 98 non-expert inv estigators below, within and above the range of evaluations by the thr ee experts were calculated. Taking over- and underscoring together, ed ema/papulation was the easiest intensity item to score (82% within the range by the experts). The global symptom score, as well as lichenifi cation, edema/papulation, oozing and excoriation registered by physici ans with dermatological experience were not statistically significantl y different from those by others. Erythema was statistically significa ntly better scored by those with dermatological experience. The result s of the Euclidean Distance method showed that the item excoriations g ave the largest distance, Erythema and excoriations were scored better by dermatologically experienced physicians (t-test, p=0.042 and p=0.0 63 respectively), but lichenification was better scored by non-dermato logically experienced physicians (p=0.013). The extent of surface area involved in the disease was calculated on 3 sets of photographs. Most evaluations by the 98 nonexpert investigators were within the range o f the experts. Dermatologically experienced physicians scored signific antly better-than the others (t-test, p=0.006). This training program is useful for standardizing the scoring in AD and indicates that SCORA D can be used by investigators from different disciplines.