Developing a simplified assessment scale of severity and simplified criteria for initiating systemic treatment for atopic dermatitis by the Delphi method

BACKGROUND: Current clinical assessment of atopic dermatitis (AD) severity and systemic treatment initiation remains problematic due to complex, time-consuming evaluation protocols. This complexity often leads to over-reliance on subjective clinical judgment, particularly in primary care settings, frequently resulting in delayed therapeutic intervention and suboptimal disease management. The project was designed to overcome these limitations by developing simplified, standardized tools for AD severity assessment and systemic treatment decision-making, with the ultimate goals of enhancing clinical efficiency and improving patient outcomes. METHODS: An initial pool of indicators for the Simplified AD Assessment Scale was created through a comprehensive literature review and expert consultations. A two-round electronic Delphi survey was subsequently conducted with 16 senior dermatologists from China to evaluate and refine these indicators and to establish consensus criteria for initiating systemic treatment. The study was conducted from November 2023 to June 2024. RESULTS: Through a two-round Delphi consensus process, we developed: First, a Simplified AD Assessment Scale comprising three primary indicators (pruritus, skin lesions, and quality of life) and five secondary indicators (intensity of itch, impact of itching on sleep, skin lesion involvement of body surface area (BSA), comprehensive evaluation of the intensity of skin lesion signs, and comprehensive evaluation of the impact on daily activities). Second, a Simplified Criteria for Initiating Systemic Treatment, including (A) skin lesion involvement >10% of BSA, or <10% BSA involving sensitive or highly visible areas, or inadequate response to prior topical therapies; (B) severe sleep disruption due to itching, necessitating sleep aids or causing awakening; and (C) significant impairment of daily activities, including work, study, or social activities. Systemic therapy was recommended when it co-occurs with either B or C. The Simplified AD Assessment Scale and systemic therapy initiation criteria offer three distinct clinical advantages for Chinese practice settings: (1) superior practicality through qualitative descriptors replacing cumbersome quantitative measures; (2) comprehensive evaluation via integrated patient-reported and physician-assessed parameters; and (3) regionally adapted decision-making as the first Chinese consensus-derived assessment tool. While demonstrating immediate clinical utility, further validation studies are necessary to establish the reliability, validity, and clinical applicability of these newly proposed tools. CONCLUSION: The Simplified AD Assessment Scale and the associated criteria for initiating systemic therapy could enhance clinical efficiency and streamline decision-making processes for Chinese dermatologists in AD management.