Robert Sidbury, MD, MPH, and Ruchi S. Gupta, MD, MPH, prepared useful practice aids pertaining to atopic dermatitis for this CME activity titled "A Closer Look at the Atopic Dermatitis Patient Journey: Effective Management Approaches Across the Age and Disease Spectrum." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2PpDRMR. CME credit will be available until November 12, 2020.

1. Access the activity, “A Closer Look at the Atopic Dermatitis Patient Journey: Effective Management
Approaches Across the Age and Disease Spectrum,” at PeerView.com/XHY40.
Tools to Assess the Severity
of Atopic Dermatitis
PRACTICE AID
The Scoring of Atopic Dermatitis (SCORAD) Tool for Measuring Disease Severity
(European Task Force on Atopic Dermatitis, 1993)1
A: Extent: Please indicate area involved.
B: Intensity
Criteria Intensity Means of Calculation
Erythema
Intensity Items
(Average
representative area)
0 – absence
1 – mild
2 – moderate
3 – severe
Edema/papulation
Oozing/crust
Excoriation
Lichenification
Drynessa
a
Dryness is evaluated on involved areas.
C: Subjective Symptoms: pruritus and sleep loss
Visual analog scale (average for the last 3 days or nights)
SCORAD: A/5+7B/2+C
SCORAD Results
SCORAD Intensity Scoring2
Pruritus (0-10)
Sleep loss (0-10)
A: total area; possible
maximum of 100%
B: intensity scores
are added together;
possible maximum
of 18
C: subjective symptoms
(itch/sleeplessness) scored
by patient or relative
using a VAS
• 0 is no itch (or no
sleeplessness)
• 10 is the worst
imaginable itch (or
sleeplessness)
• Possible maximum of 20
With a maximum possible SCORAD score of 103,
patients with a score >50 are typically considered to
have severe atopic dermatitis, while those with a score
<25 are considered to have mild disease
• Most cases of allergic dermatitis are mild with <10%
considered severe
• Severe disease does seem to be more common in
adult patients
0
0
10
10
Figures in parentheses
for children under
2 years of age
Intensity
Redness
Swelling
Oozing/crusting
Scratch marks
Skin thickening
(lichenification)
Dryness
None Mild Moderate Severe
Score 0
Score 0
Score 0
Score 0
Score 0
Score 1 Score 2 Score 3
Score 1 Score 2 Score 3
Score 1 Score 2 Score 3
Score 1 Score 2 Score 3
Score 1 Score 2 Score 3

2. Access the activity, “A Closer Look at the Atopic Dermatitis Patient Journey: Effective Management
Approaches Across the Age and Disease Spectrum,” at PeerView.com/XHY40.
Tools to Assess the Severity
of Atopic Dermatitis
PRACTICE AID
1. European Task Force on Atopic Dermatitis. Dermatology. 1993;186:23-31. 2. https://www.dermnetnz.org/topics/scorad/. Accessed October 3, 2019. 3. https://www.eczemacouncil.org/wp-content/
uploads/2018/02/Validated-Investigator-Global-Assessment-Scale_vIGA-AD_2017.pdf. Accessed October 3, 2019. 4. https://www.nice.org.uk/guidance/cg57/resources/atopic-eczema-in-under-12s-
diagnosis-and-management-975512529349. Accessed October 3, 2019.
Validated Investigator Global Assessment Scale for Atopic Dermatitis3
Score Morphological Description
0 – Clear
• No inflammatory signs of atopic dermatitis (no erythema, no induration/
papulation, no lichenification, no oozing/crusting)
• Postinflammatory hyperpigmentation and/or hypopigmentation may be present
1 – Almost clear
• Barely perceptible erythema, barely perceptible induration/papulation, and/or
minimal lichenification
• No oozing or crusting
2 – Mild
• Slight but definite erythema (pink), slight but definite induration/papulation,
and/or slight but definite lichenification
• No oozing or crusting
3 – Moderate
• Clearly perceptible erythema (dull red), clearly perceptible induration/papulation,
and/or clearly perceptible lichenification
• Oozing and crusting may be present
4 – Severe
• Marked erythema (deep or bright red), marked induration/papulation, and/or
marked lichenification
• Disease is widespread in extent
• Oozing or crusting may be present
Visual Assessment of Severity Proposed by the United Kingdom
National Institute for Health and Care Excellence4
Mild
• Areas of dry skin,
infrequent itching (with
or without small areas of
redness)
• Little impact on everyday
activities, sleep, and
psychosocial well-being
Moderate
• Areas of dry skin, frequent
itching, redness (with or
without excoriation and
localized skin thickening)
• Moderate impact on
everyday activities and
psychosocial well-being;
frequently disturbed
sleep
Severe
• Widespread areas of
dry skin, incessant
itching, redness (with
or without excoriation,
extensive skin thickening,
bleeding, oozing,
cracking, and alteration of
pigmentation)
• Severe limitation of
everyday activities and
psychosocial functioning,
nightly loss of sleep

3. Atopic Dermatitis Yardstick:
A Step-Care Approach to Patient Management1
AD: atopic dermatitis; TCI: topical calcineurin inhibitor; TCS: topical corticosteroids.
1. Boguniewicz M et al. Ann Allergy Asthma Immunol. 2018;120:10-22
PRACTICE AID
Access the activity, “A Closer Look at the Atopic Dermatitis Patient Journey: Effective Management Approaches Across
the Age and Disease Spectrum,” at PeerView.com/XHY40.
Maintenance
Treatment
Acute
Treatment
Nonlesional
Mild
Moderate
Severe
BASIC MANAGEMENT
Apply TCS to Inflamed Skin
Low- to medium-potency TCS 2x daily for 3-7 days beyond clearance
(Consider TCI, crisaborole)
BASIC MANAGEMENT
BASIC MANAGEMENT +
TOPICAL ANTI-INFLAMMATORY
MEDICATION
Apply TCS to Inflamed Skin
Medium- to high-potency
TCS 2x daily for 3-7 days
beyond clearance
(Consider TCI, crisaborole)
Apply on areas of previous/
potential symptoms (AKA flare)
BASIC MANAGEMENT +
REFERRAL TO AD SPECIALIST
1. Skin care
• Moisturizer, liberal and frequent
(choice per patient preference)
• Warm baths/showers using
nonsoap cleansers, usually
once daily and followed by
moisturizer (even on clear areas)
2. Trigger avoidance
• Proven allergens and common
irritants
• Consider comorbidities
1. Skin care
• Moisturizer, liberal and frequent
(choice per patient preference)
• Warm baths/showers using
nonsoap cleansers, usually
once daily and followed by
moisturizer (even on clear areas)
2. Antiseptic measures
• Dilute bleach bath (or equivalent)
≤2x/week according to severity
(especially with recurrent infections)
• Antibiotics, if needed
3. Trigger avoidance
• Proven allergens and common
irritants
• Consider comorbidities
Maintenance TCS
• Low-potency 1-2x daily
(including face)
• Medium potency 1-2x weekly
(except face)
Or
Maintenance TCI
(pimecrolimus, tacrolimus)
• 1-2x daily
• 2-3x weekly (not an indicated
dosage)
Or
Crisaborole 2%
• 2x daily
Phototherapy
Dupilumab
Systemic Immunosuppressants
• Cyclosporine A
• Methotrexate
• Mycophenolate mofetil
• Azathioprine
• Corticosteroids
Consider acute treatment for some
patients to help gain control
• Wet wrap therapy
• Short-term hospitalization
If not resolved in 7 days, consider
• Non-adherence
• Infection
• Misdiagnosis
• Contact allergy to medications
• Referral

4. Access the activity, “A Closer Look at the Atopic Dermatitis Patient Journey: Effective Management
Approaches Across the Age and Disease Spectrum,” at PeerView.com/XHY40.
Topical Steroids Identified by
Potency and Availability1
PRACTICE AID
C: cream; L: lotion; O: ointment.
1. Dimitriades VR, Wisner E. Pediatric Health Med Ther. 2015;6:93-99.
Potency Medication Vehicle Size Available
Class I (ultra high)
Betamethasone dipropionate 0.05% O 15 g, 45 g
Clobetasol propionate 0.05%
O, C
L
15-60 g
30-120 mL
Class II (high)
Halobetasol propionate 0.05% O, C 15 g, 50 g
Betamethasone dipropionate 0.05% C 15 g, 45 g
Desoximetasone 0.25% O, C 15 g, 60 g, 100 g
Fluocinonide 0.05% O, C 30 g, 60 g
Halcinonide 0.1% O, C 15 g, 30 g, 60 g
Mometasone furoate 0.1% O 15 g, 45 g
Class III (medium to high)
Betamethasone dipropionate 0.05% L 30 mL, 60 mL
Desoximetasone 0.05% C 15 g, 60 g
Fluticasone propionate 0.005% O 15 g, 30 g
Triamcinolone acetonide 0.5% O, C 15 g
Class IV (medium)
Fluocinolone acetonide 0.025% O 15 g, 30 g, 60 g
Hydrocortisone butyrate 0.1% O 15 g, 45 g
Hydrocortisone valerate 0.2% O 15 g, 45 g, 60 g
Mometasone furoate 0.1% O 15 g, 45 g
Triamcinolone acetonide 0.1%
O
C
L
15-454 g
15 g, 60 g, 80 g
60 mL
Class V (medium to low)
Betamethasone valerate 0.1% C 15 g, 45 g
Fluocinolone acetonide 0.025% C 15 g, 30 g, 60 g
Hydrocortisone butyrate 0.1% C 15 g, 45 g, 60 g
Hydrocortisone valerate 0.2% C 15 g, 45 g, 60 g
Mometasone furoate 0.1%
C
L
15 g, 45 g
30 mL, 60 mL
Triamcinolone acetonide 0.025%
O
C
L
15-454 g
15 g, 80 g
60 mL
Class VI (low)
Alclometasone dipropionate 0.05% O, C 15 g, 45 g, 60 g
Desonide 0.05%
C
L
15 g, 60 g
60 mL, 120 mL
Class VII (mild)
Fluocinolone acetonide 0.01% C 15 g, 60 g
Hydrocortisone 0.5%–2.5%
O, C
L
15-454 g
60 mL, 120 mL