EASI score

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated January 2015.

What is an EASI score?

An EASI score is a tool used to measure the extent (area) and severity of atopic eczema (Eczema Area and Severity Index). It takes a few minutes and experience to calculate it accurately. Then it's easy!

EASI score does not include a grade for dryness or scaling.

Body regions

There are four body regions:

Area score

Area score is recorded for each of the four regions of the body. The area score is the percentage of skin affected by eczema.

Area scorePercentage of skin affected by eczema in each region
0 0: no eczema in this region
1 1–9%
2 10–29%
3 30–49%
4 50–69%
5 70–89%
6 90–100%: the entire region is affected by eczema

Severity score

Severity score is recorded for each of the four regions of the body. The severity score is the sum of the intensity scores for four signs. The four signs are:

  1. Redness (erythema, inflammation)
  2. Thickness (induration, papulation, swelling—acute eczema)
  3. Scratching (excoriation)
  4. Lichenification (lined skin, prurigo noduleschronic eczema).

The average intensity of each sign in each body region is assessed as: none (0), mild (1), moderate (2) and severe (3).

ScoreIntensity of redness, thickness/swelling, scratching, lichenification
0 None, absent
1 Mild
2 Moderate
3 Severe

Half scores are allowed. It may be difficult to assess redness in dark skin. If in doubt, increase the average redness score by one level. The 16 images below have been chosen as typical examples of different intensities of each sign.

IntensityNoneMildModerateSevere
Redness erythema0
Score 0
erythema1
Score 1
erythema2
Score 2
erythema3
Score 3
Thickness/induration indur0
Score 0
indur1
Score 1
indur2
Score 2
indur3
Score 3
Scratching excor0
Score 0
excor1
Score 1
excor2
Score 2
excor3
Score 3
Lichenification/prurigo lichen0
Score 0
lichen1
Score 1
lichen2
Score 2
lichen3
Score 3
Four signs of eczema used to calculate EASI severity score

Calculations

For each region, record the intensity for each of four signs and calculate the severity score.

For each region, multiple the severity score by the area score and by a multiplier. The multiplier is different for each body site.

Add up the total scores for each region to determine the final EASI score. The minimum EASI score is 0 and the maximum EASI score is 72.

Recording the EASI score

Recording the EASI score
Body regionRednessThicknessScratchingLichenificationSeverity scoreArea scoreMultiplierRegion score
Head/neck _______ +_______ +_______ +_______ =_______ X_______ X 0.1 (If ≤7 yrs, X 0.2) =_______
Trunk _______ +_______ +_______ +_______ =_______ X_______ X 0.3 =_______
Upper limbs _______ +_______ +_______ +_______ =_______ X_______ X 0.2 =_______
Lower limbs _______ +_______ +_______ +_______ =_______ X_______ X 0.4 (If ≤7 yrs, X 0.3) =_______
The final EASI score: add up the 4 region scores          =_______ (0-72)

Example of an EASI score calculation

A 3-year-old child has an acute flare-up of atopic eczema. The flare-up affects limb flexures, and the child's trunk is also rather pink and dry.

The calculations for each region are severity score x area score x multiplier.

EASI = 2.4 + 1.0 + 6.0 = 9.4.

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