score atopic dermatitis evolution

ASCORAD: The Next-Generation Atopic Dermatitis automatic scoring system

Table of Contents

    Introduction

    Legit.Health unveils the future of the application of the SCORAD system: the ASCORAD (Automatic Scoring Of Atopic Dermatitis). By using computer vision algorithms, the researchers have created a tool that processes smartphone images and automatically translates them into the domain of the SCORAD.

    As we all know: objective, reliable, and precise outcome measures are a prerequisite to evidence-based health care. When considering atopic dermatitis, the EASI and SCORAD have proven to have the best measurement properties and are the most recommended for use in future clinical trials. However…

    Having to estimate the redness of the affected area just by looking at it feels very outdated.

    Dr. Ramon Grimalt

    Do you want to see the Automatic SCORAD algorithms in action?

    A lot has changed since 1993

    We owe a lot to the European Task Force on atopic dermatitis that published the first SCORAD paper in 1993. They were trying to tackle a huge obstacle both in clinical practice and clinical trials for treatments. As the authors stated:

    Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret.

    Severity Scoring of atopic dermatitis: The SCORAD Index. (1993). Dermatology, 186(1), 23–31. doi:10.1159/000247298 

    This was the premise that led Alain Taïeb and Jean-François Stalder to take on the difficult task of developing a composite severity index along with a brilliant team of researchers.

    The pen and paper SCORAD

    The solution proposed in 1993 may seem somewhat old school today, but it is a very bright way of tackling the problem. They aimed to create an evaluation system that was mostly based on simplicity and easy routine use. To do so, they created the following sheet of paper as a template:

    atopic dermatitis SCORAD

    The SCORAD Index formula is: A/5 + 7B/2 + C. In this formula, A is defined as the extent (0–100), B is defined as the intensity (0–18) and C is defined as the subjective symptoms (0–20). The maximal score of the SCORAD Index is 103.

    SCORAD template
    Sheet of paper containing the SCORAD template for clinical practice

    The digital approach: online calculators

    With the digital revolution and the rise of computers, researchers from all over the world developed digital versions of the pen and paper SCORAD.

    The main advantage of these systems is that they automatically perform the calculation of the formula A/5 + 7B/2 + C, and thats why is that people call them Digital calculators. However, the digital calculators have the same limitations as their pen-and-paper precursors: they are still very subjective and require a lot of time, as well as knowledge, to properly use the tool.

    The next generation: automatic scoring

    ASCORAD
    The evolution of the usage of the SCORAD, culminating in the ASCORAD.

    Legit.Health is the revolutionary Clinical Data and Communication tool for Next-generation dermatologists that triples the empowerment of patients. The technology speeds up the pathology reporting process and increases patients’ autonomy and control.

    The main goal of Legit.Health is to provide a tool to record data precisely and consistently for routine evaluations and clinical studies. And that is why the company is revolutionizing the SCORAD by creating the next-generation scoring of atopic dermatitis: the Automatic SCORAD, o ASCORAD for short.

    Thanks to the deep learning algorithms, Legit.Health relieves doctors from the tedious manual calculation of scoring systems and allows the practice of a more objective evidence-based dermatology. Also, by using algorithms to estimate the dryness, lichenification, erythema, oozing, and edema of images, the tool can calculate visual signs in a more subjective and stable way.

    Pen and PaperDigitalAutomatic (AI)
    Self SupervisionPerforms diagnosis
    Ease of use≈ 600 seconds≈ 420 seconds≈ 23 seconds
    Sensitivity to change0 to 40 to 40 to 100
    Interobserver variabilityMedium (20%)Medium (20%)Lowest (8%)
    Intra-observer variabilityHighHighZero

    Do you want to see the Automatic SCORAD algorithms in action?

    The problem with the SCORAD

    It is a well-documented fact that SCORAD is a valid, internally consistent, responsive, interpretable composite score that includes the intensity and extent of clinical signs of atopic dermatitis and the severity of its symptoms

    That is precisely why Legit.Health has chosen this scoring system to serve as the basis for its revolutionary algorithm. In other words: the SCORAD becomes the framework to automate the scoring of the disease with deep learning. However, the traditional SCORAD carries a set of problems and limitations

    Indeed, the SCORAD scoring system is representative and well evaluated, but shows, as with all other systems, intra and interobserver disagreements. The variation in scores is about 20%.

    Oranje, A. P., Glazenburg, E. J., Wolkerstorfer, A., & de Waard-van der Spek, F. B. (2007). Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. British Journal of Dermatology, 157(4), 645–648. doi:10.1111/j.1365-2133.2007.08112.x 

    As well as that, filling up the sheet has proven to be too tedious for some dermatologists. In many cases, doctors deem that the effort of filling in the SCORAD is too high and they end up not using it in their day-to-day clinical practice. This may be the main reason behind the popularity of the EASI, which sacrifices granularity for the benefit of becoming a simpler and quicker scoring system.

    Now, let’s understand how

    ASCORAD improves the clinimetric properties of SCORAD and becomes a better outcome measure.

    Alfonso Medela, CAIO

    How do we know what scoring system is better?

    Among the many criteria for rating the quality of outcome measures, some stand out as key to determining whether a scoring system is useful:

    • timer1. Ease of useCan be applied easily, given constraints of time and money
    • gradient2. Sensitivity to changeAbility to detect clinically important changes over time
    • theater_comedy3. Interobserver reliabilityDifferent investigators provide identical results
    • thumbs_up_down4. Intra-observer variabilityRepeated measurement by the same investigator provide identical results
    • speed5. InterpretabilityAssigns qualitative meaning to scores (mild, severe…)

    Methods and definitions to rate the quality of outcome measures. Schmitt, J., Langan, S., Deckert, S., Svensson, A., von Kobyletzki, L., Thomas, K., & Spuls, P. (2013). Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation. Journal of Allergy and Clinical Immunology, 132(6), 1337–1347. doi:10.1016/j.jaci.2013.07.008

    Six ways in which ASCORAD is better

    Legit.Health‘s algorithms automatically grade lesions just by looking at smartphone images and small patient-reported outcome measures (PROMs). In other words: the tool will automatically fill in most of the dermatology scoring systems, such as PASISCORADUASGAGS, and many more.

    The main goal of ASCORAD is to provide a tool to record data precisely and consistently for routine evaluations and clinical studies.

    1. It’s self supervised: the algorithm makes sure it’s atopic dermatitis

    When using the ASCORAD, medical professionals are assessing the diagnosis of the pathology while estimating the severity. This means that if the ASCORAD is the wrong scoring system because it’s not really atopic dermatitis, the tool with let the doctor know that there may be a mismatch.

    Legit.Health‘s tool not only measures the severity of the affection as the SCORAD does but the algorithm has been trained using the input of top doctors in their field to be able to distinguish between 232 pathologies, most kinds of dermatitis included.

    This means that ASCORAD will not confuse a case of atopic dermatitis with some of the usual suspects for misdiagnosis such ass neurodermatitis or sebaceous dermatitis, improving the rate of correct diagnosis of the doctor by 23%

    2. ASCORAD is easier to use than SCORAD and EASI

    The [traditional] SCORAD system takes time and even experienced dermatologists will require seven (7) minuntes in total. An inexperienced physician will need 10 min.

    Oranje, A. P., Glazenburg, E. J., Wolkerstorfer, A., & de Waard-van der Spek, F. B. (2007). Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. British Journal of Dermatology, 157(4), 645–648. doi:10.1111/j.1365-2133.2007.08112.x 

    On the other hand, using the ASCORAD only takes 23 seconds to get the final score. Additionally, said score and the image it came from are neatly archived and labeled for future assessment.

    ASCORAD estimates the affected surface and the intensity of and all visual signs of the disease simultaneously, improving the efficiency of both tasks.

    Do you want to see the Automatic SCORAD algorithms in action?

    Overall, ASCORAD helps practice evidence-based dermatology, relieving doctors from the tedious SCORAD calculation, enabling patients to track atopic dermatitis severity in a user-friendly and objective way, and allowing a more precise evaluation of new treatments.

    3. ASCORAD has the highest sensitivity to change

    Legit.Health‘s tool identifies pathologies using validated score systems that have:

    • add_taskLowest Minimal important Difference (MID)
    • find_in_pageLowest Smallest detectable Change (SDC)
    • add_to_home_screenHigher validity and reliability

    Furthermore, the algorithms provide additional data with comparable clinimetric properties and higher sensitivity to change and MIDs, thanks to the intrinsic functioning of computer vision algorithms.

    4. Lowest inter-observer variability

    Indeed, the SCORAD scoring system is representative and well evaluated, but shows, as with all other systems, intra and interobserver disagreements. The variation in scores is about 20%.

    Oranje, A. P., Glazenburg, E. J., Wolkerstorfer, A., & de Waard-van der Spek, F. B. (2007). Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. British Journal of Dermatology, 157(4), 645–648. doi:10.1111/j.1365-2133.2007.08112.x 

    The experimental results show that ASCORAD can achieve the mean absolute percentage error of 8%, outperforming baseline methods and below the inter-observer variability of 20%.

    5. Zero intra-observer variability

    The digital nature of the ASCORAD system eliminates completely the intra-observer variability, as every image and calculation is stored in the app’s database.

    Allowing the doctor to not rely on his memory when assessing the severity of the affection and focusing on the analysis of the objective data stored in the app reduces considerably the risk of misremembering, providing a more objective, accurate, and precise way of tracing the development of the disease.

    6. Better interpratibility

    Legit.Health provides an easy-to-read interface that gives the doctor access to all the relevant information about the patient in one look.

    Every data derived from the ASCORAD is displayed clearly on the screen, providing the severity of the affection, the different factors considered when analyzing the image and their punctuations, and an evolution across time graff that follows the healing process effectiveness of the treatment really easy.

    Additionally, every photo of the patient’s history is easily accessible, providing a backlog of images where the algorithm highlights the affected areas automatically.

    ASCORAD: The Next-Generation Atopic Dermatitis automatic scoring system
    Screen capture of the Legit.Health application https://app.legit.health

    In conclusion

    The revolutionary ASCORAD represents the future of dermatology. Allowing doctors across the globe to practice evidence-based medicine by using the best tool during the disease diagnosis while improving the effective communication between doctor and patient.

    The use of algorithms that estimate the severity of atopic dermatitis by filling up the SCORAD and automatically score lesions just by looking at smartphone images increases the doctors’ correct diagnosis rate by 23% and improves the following of the treatment by making the patient a more active participant on its own recovery.

    Get access now

    This free 23-day trial of Legit.Health gives clinics and hospitals a hands-on look at how to drive increased adherence and improve patient outcomes, as well as improving efficiency and overall quality of life.

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