Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice
Authors: Leshem Yael A. , Chalmers Joanne R. , Apfelbacher Christian , Katoh Norito , Gerbens Louise A. A. , Schmitt Jochen , Spuls Phyllis I. , Thomas Kim S. , Howells Laura , Williams Hywel C. , Simpson Eric L. ,   Harmonising Outcome Measures for Eczema (HOME) initiative, Abuabara Katrina , Ahn Jiyoung , Aoki Valeria , Apfelbacher Christian , Arai Takahiro , Arents Bernd , Awici-Rasmussen Maren , Baker Arabella , Bang Bo , Baughman Lauren , Beck Lisa , Bosma Angela , Burton Tim , Byrnes Vanessa , Calimlim Brian , Capozza Korey , Chalmers Jo , Chavda Rajeev , DeLozier Amy , Drucker Aaron , Ebata Toshiya , Eichenfield Laurence , Flohr Carsten , Frey Surina , Futamura Masaki , Gabes Michaela , George Susannah , Gerbens Louise , Grinich Erin , Grossouw Kristin , Howells Laura , Irvine Alan , Kataoka Yoko , Katoh Norito , Kerkmann Urs , Lawton Sandra , Lee Dong Hun , Leshem Yael , Lossius Astrid H. , Maeda-Chubachi Tomoko , Margolis David , Matsui Takeshi , Merhand Stephanie , Murakami Mami , Murota Hiroyuki , Nakahara Takeshi , Nunes Fabio , Ohya Yukihiro , Ong Peck , Orfali Raquel Leão , Paller Amy , Redding Magali , Rincón Pérez Catalina , Roberts Amanda , Rogers Natasha , Schmitt Jochen , Shear Neil , Silverberg Jonathan , Simpson Eric , Singh Jasvidner , Smith Begolka Wendy , Spuls Phyllis , Stalder Jean-Francois , Sugerman Philip , Svensson Ake , Thomas Kim , Thyssen Jacob , Todd Gail , van der Most Floor , van Halewijn Karlijn , Vestby Helle , Vestergaard Christian , Volke Annika , von Kobyletzki Laura , Wahlgren Carl-Fredrik , Weisshaar Elke , Williams Hywel , Wollenberg Andreas , Zhao Yang 
Published: October 2022

Importance

Measuring outcomes in clinical practice can aid patient care, quality improvement, and real-world evidence generation. The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is developing a list of validated, feasible instruments to measure atopic eczema in clinical care. Prior work identified symptoms and long-term control as the most important domains to measure in clinical practice. The Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were recommended by consensus to measure symptoms in clinical practice, but a need for instruments to measure itch intensity specifically was recognized. The HOME group also previously decided that long-term control should be captured by repeated measurements of eczema control. Recommended instruments to measure eczema control in clinical practice have not been defined.

Objective

To recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice.

Evidence Review

Available instruments to measure eczema control and itch intensity were identified through systematic reviews, informing a consensus process held at the HOME VIII virtual online meeting (October 6 and October 9, 2020). Feasibility aspects were highlighted to optimize instrument selection for the clinical practice. Consensus on an instrument was reached if fewer than 30% of the voters disagreed.

Findings

Of 7 identified instruments, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were the recommended instruments to measure eczema control (3 of 63 [5%] and 7 of 69 [10%] of voters disagreed, respectively). A single-question patient global assessment garnered support, but the current available instrument did not reach consensus. Six available itch-intensity instruments were identified. Of them, 3 instruments were recommended by consensus: a peak 24-hour numeric rating scale (NRS)-itch, and 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire, measuring average and peak itch (11 of 63 [17%], 14 of 63 [22%], and 16 of 59 [27%] voters disagreed, respectively).

Conclusions and Relevance

Clinicians and patients are encouraged to incorporate these well-validated, quick-to-perform, and easy-to-use instruments into their clinic, selecting the instruments that best fit their need. These assessments are meant to enhance, not replace, the patient–clinician encounter, and to support real-world research and health care improvement.