Background: Scoring systems for assessing the signs of atopic dermatitis (AD) are complex and difficult to interpret. Severity strata are helpful to interpret these assessments properly. Objectives: To confirm previously reported strata for the Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD) and the objective component of SCORAD (oSCORAD), and to develop strata for the modified EASI (mEASI), Atopic Dermatitis Severity Index (ADSI) and body surface area (BSA) for use in adults with AD. Methods: Skin examination was performed in 673 adolescents and adults (age ≥ 13 years) with diagnosed AD, in a dermatology practice setting. Strata were selected using an anchoring approach based on a four-point Investigator's Global Assessment of severity (clear of active skin lesions, mild, moderate or severe disease). Results: We determined potential severity strata for EASI (0 clear, 0·1–5·9 mild, 6·0–22·9 moderate, 23·0–72 severe; κ = 0·69), mEASI (0–0·9 clear, 1–8·9 mild, 9·0–29·9 moderate, 30·0–90 severe; κ = 0·71), oSCORAD (0–7·9 clear, 8·0–23·9 mild, 24·0–37·9 moderate, 38·0–83 severe; κ = 0·70), SCORAD (0–9·9 clear, 10·0–28·9 mild, 29·0–48·9 moderate, 49·0–103 severe; κ = 0·68), ADSI (0–1·9 clear, 2–5·9 mild, 6·0–8·9 moderate, 9·0–15 severe; κ = 0·55) and BSA (0 clear, 0·1–15·9 mild, 16·0–39·9 moderate, 40·0–100 severe; κ = 0·66). oSCORAD values > 0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD. Similarly, SCORAD values > 0 were found in clear skin due to the scoring of xerosis, pruritus and sleeplessness. Similarly, mEASI and ADSI scores > 0 occurred in patients with clear skin due to scoring of pruritus. Conclusions: We recommend using these strata for interpretation of their respective measures in clinical trials of AD. There are important differences between the five assessments, which profoundly impact the interpretation of their scores.
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