Eczema Severity Scoring in Skin of Color: A Review of Current Best Practice and Need for Future Improvement

Patient- and investigator-reported outcome measures are used in research and clinical practice to assess the severity and impact of atopic dermatitis (AD). Initial validation studies of the most commonly used outcome measures for AD underrepresent patients with skin of color or fail to report race, ethnicity, and skin color altogether. Various adaptations have been proposed. Upgrading the erythema score by 1 when using the Eczema Area and Severity Index in patients with skin of color has been suggested but has not yet been validated. However, the use of a "grey scale" in place of the erythema component has been reported to improve inter-rater reliability. Patients of different ethnicities or with skin of color may be impacted in different ways by AD. The pooling of patient-reported outcome measures is therefore not recommended. The Patient-orientated SCORing for Atopic Dermatitis tool for Black skin is an example of a patient-reported outcome measure specifically adapted and validated for Black skin. Novel methods for assessing AD severity include biomarker assessment using tape strips, photonic testing, and measuring subepidermal low echogenic band thickness. In this article, we review the common and novel AD outcome measures in patients with skin of color to highlight best practices and where further research to develop, adapt, and validate outcome measures will be of benefit to patients with AD with skin of color or from minoritized ethnic groups.