It is truly difficult to objectively measure subjective symptoms such as itch intensity in patients when seen in the office - what bothers one patient tremendously may not burden another patient at all. Alternatively, assessing BSA involvement is a much more objective measurement, and identifying location of lesions in traditionally hard to treat areas is certainly much easier to do. Nevertheless, all of these factors must contribute to our ultimate AD treatment and management decisions.

Due to its inherent subjectivity, properly and objectively measuring itch intensity in patients has proven to be a difficult challenge. Nonetheless, trying to do this as accurately as possible is an important goal so we can truly understand the impact of therapies we use on itch intensity in patients. It would be nice if one day we could develop additional and perhaps less subjective itch measurements: monitors that one can wear that measure duration of time spent scratching, for example. These could be used in conjunction with subjective itch measurement scores to more fully understand the patient experience of itch.

Key Points
• Source: JAMA Dermatology
• Conclusion: “Based on a consensus process informed by systematic reviews, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were recommended to measure long-term control in eczema in clinical practice. Recommended itch-intensity instruments were a peak 24-hour numeric rating scale (NRS)-itch and peak and average 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire.”
• The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is creating a list of validated, feasible instruments to measure atopic eczema in clinical settings, with previous studies identifying symptoms and long-term control as targets in clinical practice. HOME previously recommended the Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) to measure symptoms in clinical practice, but tools to measure itch intensity are also important.
• Long-term control should be assessed via repeated measurements of eczema control, although instruments used to assess eczema control in clinical practice have yet to be elucidated.
• HOME identified tools to measure eczema control and itch intensity via systematic reviews, and were used to define a consensus process at the HOME VIII virtual online meeting (October 6 and October 9, 2020). HOME stressed feasibility aspects regarding use in clinical practice, and consensus was attained if fewer than 30% of the voters disagreed on the instrument.
• A single-question patient global assessment was desired, but the corresponding instrument did not reach consensus.