EASI score

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

Body regions

There are four body regions:

1. Head and neck
2. Upper limbs
3. Trunk
4. Lower limbs

The intensity of a representative area of eczema and the approximate percentage affected by eczema are calculated for each region.

Intensity

A representative area of eczema is selected for each body region. The intensity of redness (erythema), thickness (induration, papulation, oedema), scratching (excoriation) and lichenification (lined skin) of the eczema is assessed as none (0), mild (1), moderate (2) and severe (3). Half scores are allowed.

Eczema: severity scoring

Intensity	Absent	Mild	Moderate	Severe
Redness	Score 0	Score 1	Score 2	Score 3
Thickness	Score 0	Score 1	Score 2	Score 3
Scratching	Score 0	Score 1	Score 2	Score 3
Lichenification	Score 0	Score 1	Score 2	Score 3

Calculation for intensity

The four intensity scores are added up for each of the four body regions to give subtotals A1, A2, A3, A4.

Each subtotal is multiplied by the body surface area represented by that region.

• A1 x 0.1 gives B1 (in children 0-7 years, A1 x 0.2 gives B1)
• A2 x 0.2 gives B2
• A3 x 0.3 gives B3
• A4 x 0.4 gives B4 (in children 0-7 years, A1 x 0.3 gives B1)

Area

The percentage area affected by eczema is evaluated in the four regions of the body. In each region, the area is expressed as nil (0), 1-9% (1), 10-29% (2), 30-49% (3), 50-69% (4), 70-89% (5) or 90-100% (6).

• Head and neck
• Upper limbs
• Trunk
• Lower limbs

Calculations for area

Each of the body area scores is multiplied by the area affected.

• B1 x (0 to 6)= C1
• B2 x (0 to 6)= C2
• B3 x (0 to 6)= C3
• B4 x (0 to 6)= C4

Total score

The EASI score is C1 + C2 + C3 + C4.

Example

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 intensity score is nil, as it is unaffected: A1 is 0.
• The eczema in the elbow flexure is moderately red, mildly thickened, moderately scratched but not lichenifed: A2 is 2 + 1 + 2 = 0 = 5
• On the trunk it is mildly red, mildly thickened and not scratched or lichenified: A3 is 1 + 1 + 0 + 0 = 2.
• The eczema behind the knees is severely red, severely thickened, severely scratched and mildly lichenified: A4 is 3 + 3 + 3 + 1 = 10

The intensity scores are then adjusted as follows:

• B1 = A1 x 0.2 = 0
• B2 = A2 x 0.2 = 1.0
• B3 = A3 x 0.3 = 0.6
• B4 = A4 x 0.4 = 4.0

Less than 10% of the arms is affected, around 60% of the trunk and somewhere between 10 and 29% of the lower limbs.

• C1 = B1 x 0 = 0.0
• C2 = B2 x 1 = 1.0
• C3 = B3 x 4 = 2.4
• C4 = B4 x 2 = 8.0

EASI = C1 + C2 + C3 + C4 = 11.4