Eczema Area and Severity Index
Physician-Reported Clinical Assessment
The recommended core instrument for measuring clinical signs of atopic dermatitis, endorsed by the HOME initiative. Evaluates four body regions across four severity characteristics with support for adult and pediatric weight sets.
About the EASI
Severity Bands
| Score Range | Classification | Interpretation |
|---|---|---|
| 0 | Clear | No disease activity |
| 0.1 – 1 | Almost clear | Almost clear of disease |
| 1.1 – 7 | Mild | Mild atopic dermatitis |
| 7.1 – 21 | Moderate | Moderate atopic dermatitis |
| 21.1 – 50 | Severe | Severe atopic dermatitis |
| 50.1 – 72 | Very severe | Very severe atopic dermatitis |
Clinical Background
The EASI is the recommended core instrument for measuring clinical signs in atopic dermatitis clinical trials, as endorsed by the Harmonising Outcome Measures for Eczema (HOME) initiative. It was developed by modifying the PASI scoring system for use in eczema. The EASI evaluates four body regions (head/neck, upper extremities, trunk, lower extremities) across two domains: percentage of body surface area affected (scored 0 to 6) and intensity of four lesional signs, erythema, edema/papulation, excoriation, and lichenification (each scored 0 to 3).
Each region is weighted by its proportion of total body surface area: head/neck = 0.1, upper extremities = 0.2, trunk = 0.3, lower extremities = 0.4 for adults. For children under 8 years, the weights adjust to 0.2, 0.2, 0.3, 0.3 respectively, reflecting the proportionally larger head in younger children. The theoretical maximum score is 72.
The EASI has demonstrated high content validity, construct validity, internal consistency, and sensitivity to change. It was selected by the HOME initiative after review of more than 16 instruments as having the best overall psychometric properties. Administration time is approximately 6 minutes by a trained investigator.
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. Exp Dermatol. 2001;10(1):11-18. doi:10.1034/j.1600-0625.2001.100102.x
- Schmitt J, Spuls PI, Thomas KS, et al.. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800-807. doi:10.1016/j.jaci.2014.07.043
- Leshem YA, Hajar T, Hanifin JM, Simpson EL. What the EASI score tells us about the severity of atopic dermatitis: an interpretability study. Br J Dermatol. 2015;172(5):1353-1357. doi:10.1111/bjd.13662
- Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The Eczema Area and Severity Index - A Practical Guide. Dermatitis. 2022;33(3):187-192. doi:10.1097/der.0000000000000895
- Schmitt J, Langan S, Deckert S, et al.. Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation. J Allergy Clin Immunol. 2013;132(6):1337-1347. doi:10.1016/j.jaci.2013.07.008
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