D1.75 - Association of SCORAD Values with Skin Barrier Function Indicators in Patients with Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by recurrent flares and impaired skin barrier function. Disease severity is commonly assessed using the Scoring Atopic Dermatitis (SCORAD) index; however, SCORAD may not fully capture day-to-day physiological changes in barrier integrity. Objective measures such as transepidermal water loss (TEWL) and skin hydration (epidermal and dermal) provide quantitative markers of barrier disruption, yet their concordance with SCORAD-based severity categories remains incompletely defined. We aimed to examine associations between daily SCORAD values and objective skin barrier indicators and to compare TEWL and hydration across SCORAD-defined severity groups in adults with AD.

Ten adults with AD (5 men, 5 women; mean age 32.7 years) were enrolled. SCORAD was recorded daily with concurrent measurements of TEWL and epidermal and dermal hydration using a newly developed breathable wearable skin analyzer (Hong et al., Nature Communications, 2025). Repeated within-participant measurements were aggregated as daily means. Participants were categorized as mild (SCORAD <25), moderate (25–50), or severe (>50). Associations were assessed using Pearson and Spearman correlation coefficients. Group differences were evaluated using one-way ANOVA or the Kruskal–Wallis test, as appropriate, followed by Mann–Whitney U tests with Bonferroni adjustment for post hoc comparisons. Scatter plots and standardized (z-score) time-series plots were used to visualize between-group patterns and within-person dynamics.

Higher SCORAD values were associated with higher TEWL and lower skin hydration. The severe group exhibited substantially increased TEWL and substantially reduced epidermal and dermal hydration compared with the mild and moderate groups. SCORAD correlated positively with TEWL and negatively with hydration, and TEWL showed a strong inverse correlation with hydration. Time-series analyses demonstrated notable inter-individual variability, including episodes of physiological fluctuation despite minimal change in SCORAD.

Objective skin barrier impairment—reflected by increased TEWL and decreased hydration—tracks with clinical severity in AD. Combining SCORAD with physiological measurements may improve precision monitoring and support more individualized disease management.