Metrics for The Combined Approach to atopic eczema

author/source: DrB

In Atopic Skin Disease - Manual For Practitioners we set out a method used in clinic for assessing eczema and measuring progress when using The Combined Approach to atopic eczema. The measures used are subjective - the data are generated by the patient, aim to emphasise self-help and behavioural change, and to structure discussion and appropriate understanding of the principles involved.

As set out in the suggested treatment protocols, at the first clinic visit assessment of longstanding or chronic atopic eczema includes discussing its fluctuating course - characteristically coming and going, but never clearing up altogether. Do the better periods last days, or weeks, or months at a time? Do the worse periods last days, weeks, or months at a time? A flare-up - or worse time - is acute, or new, eczema, whilst the rest is chronic, or longstanding eczema. The Combined Approach tackles both acute and chronic eczema, while current standard treatment focuses on the treatment of acute eczema only.

At the first clinic visit it is helpful to consider quality of life effects. Standard questionnaires focus on the burden of having eczema. It is useful also to discuss the expected result in quality of life from clearing the eczema completely in a matter of four to six weeks, as usually can happen using The Combined Approach. This discussion taps into attitude and motivation for positive change in behaviour.

A focused snapshot of the situation at the first clinic visit can be recorded by asking the first four of the following questions. At subsequent clinic visits the same questions can be asked, with two more to cover a full picture of scratching behaviour:

  1. Subjective overall eczema severity score 0-10 : “What do you score your eczema today overall on a scale zero-to-ten, where ten is your eczema as bad as it can get, and zero is completely clear and healthy skin everywhere?”
  2. % Acute % Chronic: “What percentage of your overall eczema today is recent or acute, and present only for last ten days, the rest being longstanding or chronic eczema?”
  3. Body Parts affected: “Where do you have any eczema at all today?”
  4. % Recent scratching due to itch: “What percentage of your recent scratching is due to itch?”
  5. Frequency of scratching now: “What is the average frequency of your scratching episodes in the the last few days?”
  6. Circumstances of most scratching: “Which situations, activities and times seem to trigger most of your scratching recently?”