title: Lesson from performing SCORADs in children with atopic dermatitis: subjective symptoms do not correlate well with disease extent or intensity.
abstract: BACKGROUND
  Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index.
  
  
  METHODS
  Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index.
  
  
  RESULTS
  One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively.
  
  
  CONCLUSIONS
  We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms.
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. ehon@hotmail.com
authors.forename: K L E
authors.initials: KL
authors.lastname: Hon
authors.forename: T F
authors.initials: TF
authors.lastname: Leung
authors.forename: Y
authors.initials: Y
authors.lastname: Wong
authors.forename: T F
authors.initials: TF
authors.lastname: Fok
mesh_terms: D000293:Adolescent; D002648:Child; D002681:China; D003876:Dermatitis, Atopic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D011537:Pruritus / Q000209:etiology; D015203:Reproducibility of Results; D012893:Sleep Wake Disorders / Q000209:etiology