EASI Score

What is EASI Score? The EASI score, the Eczema Area and Severity Index, is one of the disease severity scales available for Eczema/Atopic Dermatitis that was developed in 1998 and is currently recommended as the main instrument for the assessment of eczema in all clinical trials.

How is EASI scoring performed?

A. The body is divided into four parts which are divided further into the percentage of the skin affected based on a standardized measure:

1. Head and Neck: Face 33% (17% for each side), Neck 33% (17% front and back), Scalp 33%

2. Trunk, including genitals: Front 55%, Back 45%.

3. Upper limbs: Each arm is designated as 50% with the front and back of each arm representing 25%.

4. Lower limbs: Each leg is designated 45% of the area with the front and back representing 22.5% each, and the buttocks representing 10% of the lower limb region.

These percentages are then used to score each of the four regions from 0-6, which are assigned the “AREA SCORE”.

0: No active signs of eczema

1: 1-9% affected

2: 10-29% affected

3: 30-49% affected

4: 50-69% affected

5: 70-89% affected

6: 90-100% affected

B. The EASI score only uses signs of inflammation as the basis for scoring, and does not grade for dryness or scaling. The signs of inflammation being scored include:

  • Erythema
  • Thickness (induration, papules, and swelling)
  • Excoriation
  • Lichenification, as defined by the presence of lined skin, furrowing, and prurigo nodules).

The severity of each sign is measured on a scale of 0-3, as absent, mild, moderate, and severe.

This severity measure of each sign is added for each body region to get the “SEVERITY SCORE”.

C. The regions are scored by multiplying the severity score, the area score, and the multiplier that represents the body surface area:

Head/Neck: 0.1 (if 7 years of age or less: 0.2)

Trunk: 0.3

Upper Limb: 0.2

Lower Limb: 0.4 (if 7 years of age of less: 0.3)

D. The Final EASI score is calculated by adding the four region scores, and can range from 0 to 75. The total severity is stratified as follows:

Clear, absent disease (0)

Almost clear (0.1-1)

Mild (1.1-7.0)

Moderate (7.1-21.0)

Severe (21.1-50.0)

Very Severe (50.1-75)

Source: Hanifin, J. M., Baghoomian, W., Grinich, E., Leshem, Y. A., Jacobson, M., & Simpson, E. L. (2022). The Eczema Area and Severity Index—A Practical Guide. Dermatitis33(3), 187–192. https://doi.org/10.1097/der.0000000000000895