Evaluation of clinical scales among populations diagnosed with atopic dermatitis: A scoping review
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Background
Common diagnostic tools for atopic dermatitis (AD) often perform worse in skin-of-colour (SOC) populations. The objective of this review is to map the prevalence, validation, and effectiveness of clinician-based and patient-reported tools for diagnosing AD in SOC groups across all ages.
Methods
This review followed PRISMA-ScR guidelines and searched Embase, Scopus, PubMed, MEDLINE, Web of Science, and MedRxiv for articles published January 2015 through December 2023. Eligible studies were observational, randomized, or review articles evaluating clinician-rated scales or patient-reported measures with self-identified race or ethnicity. We excluded non-English publications, case reports/series, guidelines, editorials, and studies lacking stratification. After de-duplication, two reviewers screened titles, abstracts, and full texts with conflicts resolved by a third reviewer. Data extraction captured study design, population demographics, tools evaluated, and key findings on accuracy and reliability in SOC cohorts.
Results
28 articles (total n = 20 332) met inclusion criteria. 24 assessed clinician-rated scales, most often EASI (n = 16), SCORAD (n = 10), and o-SCORAD (n = 8). These tools frequently underestimate AD severity in Fitzpatrick IV-VI skin types. Five studies examined alternative clinician tools (vIGA-AD, IGAxBSA). Rajka-Langeland and ADSI scores were each assessed once. Patient-reported outcomes (PROs) were dominated by POEM (n = 17), which had only 14% SOC participants during initial validation. PO-SCORAD (a PRO based on SCORAD) was also assessed (n = 10). Nine newer PRO tools (RECAP, ADCT, PSAAD, ADSEQ, CEQ, DFI, CADIS, QoLIAD, PIQoL-AD) appeared in single studies. Adjunctive measures and technological approaches (body-surface area alone, photo guides, AI-assisted analysis, remote assessment) featured in five studies but lack multi-center validation.
Conclusions
Most diagnostic tools remain validated in lighter-skinned cohorts and underrepresent SOC populations. Patient-reported measures show promise but require wider validation. Adjunctive and technology-driven methods may improve equity but need rigorous testing. Future research should prioritize multiethnic cohorts, age-specific validation, and consensus-driven adaptation of both clinician and patient-reported tools to ensure reliable assessment for all skin types.
