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. Include only inflamed areas.

Body regions

There are four body regions:

  • Head and neck
    • Face occupies 33% (17% each side), neck 33% (17% front and back) and scalp 33% of the head and neck region
  • Trunk (including genital area)
    • Front occupies 55% and back 45% of the trunk
  • Upper limbs
    • Each arm occupies 50% of the upper limbs region (front or back of one arm is 25%)
  • Lower limbs (including buttocks)
    • Each leg occupies 45% (front or back of one leg is 22.5%) and buttocks 10% of the lower limbs region

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 for each body region.

Area scorePercentage of skin affected by eczema in each region
0 No active 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, furrowing, 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 (just perceptible)
2 Moderate (obvious)
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.

Four signs of eczema used to calculate EASI severity score

Intensity of redness
Intensity of thickness/induration, papulation/oedema
Intensity of scratching
Intensity of lichenification/prurigo

Calculations

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

  • Severity score = redness intensity + thickness intensity + scratching intensity + lichenification intensity

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

  • Head and neck: severity score x area score x 0.1 (in children 0–7 years, x 0.2)
  • Trunk: severity score x area score x 0.3
  • Upper limbs: severity score x area score x 0.2
  • Lower limbs: severity score x area score x 0.4 (in children 0–7 years, x 0.3)

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 head and neck score is nil, as it is unaffected.
  • The trunk is mildly red (1), mildly thickened (1), not scratched (0) nor lichenified (0): severity score 2.
    Around 60% of the trunk is affected; area score 4.
  • The eczema in the elbow flexure is moderately red (2), mildly thickened (1), moderately scratched (2) but not lichenifed (0): severity score 5.
    Less than 10% of the arms is affected: area score 1.
  • The eczema behind the knees is severely red (3), severely thickened (3), severely scratched (3) and mildly lichenified (1): severity score 10.
    About 20% of the legs is affected: area score 2.

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

  • Head/neck: 0
  • Trunk: 2 x 4 x 0.3 = 2.4
  • Upper limbs = 5 x 1 x 0.2 = 1.0
  • Lower limbs = 10 x 2 x 0.3 = 6.0

EASI = 2.4 + 1.0 + 6.0 = 9.4.

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References

  • Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001 Feb;10(1):11-8.

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