The four you'll hear about
- EASI (Eczema Area and Severity Index) — combines how much of the body is involved with how intense the affected skin is, into one composite score. Assessed by a clinician.
- SCORAD — one of the most widely used severity scores in both trials and clinical practice. Assessed by a clinician; the full version also includes patient-reported itch and sleep loss, while "objective SCORAD" leaves those out.
- POEM (Patient-Oriented Eczema Measure) — a patient-reported measure. You answer it; nobody examines you.
- IGA (Investigator Global Assessment) — a clinician's single overall judgement, common in trials and in insurance criteria.
Why the split matters. A clinician-scored measure captures what your skin looks like in a room, on one day, under one set of lights. It cannot see the week you had, the sleep you lost, or the fact that today happens to be a good day. That is not a flaw in the tool — it is what the patient-reported measures exist for. If your assessed score keeps coming out lower than your life feels, you are not imagining the gap; you are describing the difference between two instruments.
What the field itself recommends
The Harmonising Outcome Measures for Eczema (HOME) initiative was founded in 2008 to standardise which outcomes should be measured in trials and in practice. Of the many available instruments, a systematic review found only three — SCORAD, EASI and POEM — had been evaluated sufficiently and performed adequately enough to be recommended. HOME recommends EASI as the core clinical measure and POEM as the core patient-reported one.
That pairing is the point: the field's own recommendation is that a score of your skin and a score of your experience are both needed. One without the other is an incomplete picture by design.
Why you might care
- Access. In the US, severity thresholds frequently sit inside insurance criteria for advanced treatments. A visit on a good day can genuinely cost you access. See prior authorization and appeals.
- Progress. A number recorded twice is far better evidence of change than two memories.
- Being believed. "It's been a 4 out of 10 most days for three months" lands differently from "it's been bad".
Don't score yourself
These instruments are validated in the hands of the people trained to use them, on the populations they were tested in. Assembling a number for yourself off a web description produces something that looks precise and isn't, and it can send you into an appointment arguing about the wrong thing. What is genuinely useful is bringing the raw material — how many bad days, how many broken nights, how much treatment it took — and letting the clinician score it.
Our guide on mild, moderate or severe? covers the plain-language version of severity, and preparing for an appointment covers what to bring.
A note on the numbers being low. Being told your eczema scores as "moderate" when it has taken over your life is a common and demoralising experience. It usually means the instrument measured area and intensity rather than burden. That's worth saying plainly at the appointment — "the score doesn't reflect what this is doing to me" is a legitimate sentence, and POEM exists precisely because the field agrees.
Bring the raw material a score is built from
Every one of these measures is trying to compress something you already know. Ollowen keeps the underlying record — bad days, broken nights, what it took to settle — so that whatever gets scored is scored against your real months, not the one morning you happened to be in the room.
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Sources
- Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation.
- EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference.
- Relationship between EASI and SCORAD severity assessments for atopic dermatitis.
- Patient-reported outcome measures in atopic dermatitis and chronic hand eczema in adults.
More Ollowen guides: see all →