From the Guidelines
To document an eczema rash during a physical exam, it is essential to note the extent, location, and severity of the eczema, as well as any signs of bacterial infection, such as crusting or weeping, as suggested by the study published in the BMJ in 1995 1. When documenting an eczema rash, consider the following key characteristics:
- Location and distribution of the rash
- Appearance, including color, texture, and any specific patterns
- Size of affected areas
- Severity of symptoms, such as mild, moderate, or severe
- Signs of scratching, excoriation, or secondary infection
- Associated symptoms like itching or burning It is also important to use standardized scoring systems, such as EASI (Eczema Area and Severity Index) or SCORAD (SCORing Atopic Dermatitis), for more comprehensive assessments, as recommended by the International Eczema Council in 2017 1. Additionally, documenting any changes from previous exams and the patient's response to current treatments is crucial for tracking the progression of the condition and guiding treatment decisions, as emphasized by the study published in the Journal of the American Academy of Dermatology in 2017 1. Accurate and detailed documentation of the eczema rash is vital for proper diagnosis, treatment planning, and monitoring the effectiveness of interventions, ultimately impacting the patient's quality of life and morbidity outcomes 1.
From the FDA Drug Label
Of the key signs of atopic dermatitis, erythema, infiltration/papulation, lichenification, and excoriations, The key characteristics to note when documenting an eczema (atopic dermatitis) rash in a physical exam are:
- Erythema
- Infiltration/papulation
- Lichenification
- Excoriations 2
From the Research
Key Characteristics of Eczema (Atopic Dermatitis) Rash
When documenting an eczema (atopic dermatitis) rash in a physical exam, the following key characteristics should be noted:
- Extent of involvement: This can be measured using the body surface area (BSA) affected by the rash 3, 4, 5, 6
- Severity of the rash: This can be assessed using various tools such as the Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Physician Global Assessment (PGA), and Atopic Dermatitis Severity Index (ADSI) 3, 7, 5
- Location of the affected areas: The location of the rash can affect the overall judgement of disease severity and consideration of therapy choice 3, 7
- Clinical signs: These include erythema, edema/papulation, excoriation, and lichenification, which can be rated using the EASI 7
- Disease recurrence or persistence: This should be considered in the overall judgement of disease severity and consideration of therapy choice 3
Assessment Tools
Various assessment tools can be used to measure the severity of atopic dermatitis, including:
- Eczema Area and Severity Index (EASI) 3, 7, 5
- SCORing Atopic Dermatitis (SCORAD) 3, 5
- Physician Global Assessment (PGA) 3
- Atopic Dermatitis Severity Index (ADSI) 3
- Body surface area (BSA) 3, 4, 5, 6
- Patient Oriented Eczema Measure (POEM) 3, 5
- Dermatology Life Quality Index (DLQI) 3, 5
- Pruritus Numerical Rating Scale (NRS) 3
Interobserver Agreement
The interobserver agreement for assessing the extent of disease involvement can be poor, highlighting the need for reliable methods of assessment 6. The use of standardized assessment tools and training can help improve interobserver agreement 4, 5.