The Eczema Area and Severity Index (EASI) is the standard score for the visible signs of atopic eczema. Use the EASI calculator below: choose an age group, then for each of the four body regions score redness, thickness, scratch marks and lichenification from 0 to 3 and the area affected from 0 to 6. The EASI score, its severity band and the full working update as you go.
The short answer
- EASI scores four body regions: head and neck, upper limbs, trunk and lower limbs.
- Each region gets 0 to 3 for redness, thickness or swelling, scratch marks and lichenification (half points allowed from 1.5), and 0 to 6 for the share of the region affected.
- Region weights are 0.1, 0.2, 0.3 and 0.4 from age 8, or 0.2, 0.2, 0.3 and 0.3 under 8. Scores run from 0 to 72.
- Suggested bands: 1.1 to 7.0 mild, 7.1 to 21.0 moderate, 21.1 to 50.0 severe, above 50 very severe.
- EASI 50, 75 and 90 mean a 50%, 75% or 90% fall from the starting score. NICE uses EASI 50 to judge dupilumab at 16 weeks.
Head and neck× 0.1
subtotal 0.0 of 7.2Upper limbs× 0.2
subtotal 0.0 of 14.4Trunk× 0.3
subtotal 0.0 of 21.6Lower limbs× 0.4
subtotal 0.0 of 28.8EASI score
0.0
out of a possible 72
ClearNo eczema recorded yet. Score each region; regions you leave at 0 add nothing.
Working
Upper limbs: 0.2 × (0 + 0 + 0 + 0) × 0 = 0.0
Trunk: 0.3 × (0 + 0 + 0 + 0) × 0 = 0.0
Lower limbs: 0.4 × (0 + 0 + 0 + 0) × 0 = 0.0
EASI = 0.0
Enter an earlier EASI to see the change.
For education and record-keeping. It does not diagnose eczema or decide treatment. Nothing you enter leaves your browser.
Table of Contents
How to use the EASI calculator
- Choose the age group. Under 8 changes the weights for head and neck and for the lower limbs.
- Pick one region. Work through head and neck, upper limbs, trunk and lower limbs. The feet and buttocks count as lower limbs; the armpits and groin count as trunk.
- Score the four signs. Rate the average redness, thickness or swelling, scratch marks and lichenification across the eczema in that region: 0 none, 1 mild, 2 moderate, 3 severe. Use 1.5 or 2.5 for in-between grades.
- Score the area. Choose the share of that region with active eczema, from 0 (none) to 6 (90 to 100%).
- Read the result. The EASI score, severity band, region subtotals and working update as you go. To track treatment, enter an earlier EASI to see the change in points and percent.
Select a region on the body map to jump to it. Use Copy result to paste the score and working into notes.
How the EASI score is calculated
For each region, the EASI adds the four sign scores, multiplies by the area score, then multiplies by a weight for that region. The four region scores are added together:
Region score = (redness + thickness + scratch marks + lichenification) × area score × region weight
EASI = head and neck + upper limbs + trunk + lower limbs
Severity scores for the four signs
The four signs are erythema (redness), oedema or papulation (thickness and swelling), excoriation (scratch marks) and lichenification (thickened, leathery skin with exaggerated skin lines). Half points can be used between 1 and 3, but not 0.5, because any sign that is present counts as at least mild (Dermatitis, 2022).
| Score | Intensity |
|---|---|
| 0 | None (absent) |
| 1 | Mild (just perceptible) |
| 1.5 | Between mild and moderate |
| 2 | Moderate (obvious) |
| 2.5 | Between moderate and severe |
| 3 | Severe |
Area scores
The area score is the share of that one region with active eczema, not the share of the whole body.
| Score | Share of the region affected |
|---|---|
| 0 | 0% (no active eczema) |
| 1 | 1–9% |
| 2 | 10–29% |
| 3 | 30–49% |
| 4 | 50–69% |
| 5 | 70–89% |
| 6 | 90–100% |
Region weights
Each region is multiplied by the amount of body surface it represents, which differs for young children.
| Region | Age 8 and over | Under 8 | What it includes |
|---|---|---|---|
| Head and neck | 0.1 | 0.2 | Face, scalp and neck (about a third each) |
| Upper limbs | 0.2 | 0.2 | Both arms (half each) |
| Trunk | 0.3 | 0.3 | Front (55%) and back (45%), including the armpits, groin and genital area |
| Lower limbs | 0.4 | 0.3 | Both legs (45% each), buttocks (10%) and feet |
Region shares are from DermNet. In both age groups the weights add up to 1, so the maximum EASI is 72.
Worked example
An adult with eczema in all four regions might be scored like this:
| Region | Redness + thickness + scratch marks + lichenification | Area score | Subtotal |
|---|---|---|---|
| Head and neck | 2 + 1 + 1 + 0 = 4.0 | 2 | 0.1 × 4.0 × 2 = 0.8 |
| Upper limbs | 2 + 2 + 1.5 + 1 = 6.5 | 2 | 0.2 × 6.5 × 2 = 2.6 |
| Trunk | 1 + 1 + 0 + 0 = 2.0 | 1 | 0.3 × 2.0 × 1 = 0.6 |
| Lower limbs | 2.5 + 2 + 2 + 2 = 8.5 | 3 | 0.4 × 8.5 × 3 = 10.2 |
Adding the four subtotals gives 0.8 + 2.6 + 0.6 + 10.2 = EASI 14.2, which falls in the moderate band. The lower limbs carry the most weight, so they produce most of this score.
What does an EASI score mean?
An EASI of 0 means no active eczema was recorded. The maximum is 72. A 2015 interpretability study in the British Journal of Dermatology matched EASI scores in children and adults against the Investigator’s Global Assessment and suggested these severity bands:
| EASI score | Severity |
|---|---|
| 0 | Clear |
| 0.1 to 1.0 | Almost clear |
| 1.1 to 7.0 | Mild |
| 7.1 to 21.0 | Moderate |
| 21.1 to 50.0 | Severe |
| 50.1 to 72.0 | Very severe |
Source: Br J Dermatol, 2015. The same study found that trained assessors took about 6 minutes to complete an EASI. Because EASI covers signs only, it is often read alongside a quality of life score such as the Dermatology Life Quality Index (DLQI), the Children’s DLQI or, for young children, the Infants’ Dermatitis Quality of Life Index.
EASI 50, EASI 75 and EASI 90
Treatment response is measured as the percentage fall from the starting (baseline) EASI. EASI 50 and EASI 75 mean a 50% and 75% improvement from baseline (Acta Dermato-Venereologica); EASI 75 was the primary endpoint of the CHRONOS dupilumab study. EASI 90 and EASI 100 follow the same pattern.
| Response | Fall from baseline | Example from a baseline of 20 |
|---|---|---|
| EASI 50 | 50% or more | 10 or lower |
| EASI 75 | 75% or more | 5 or lower |
| EASI 90 | 90% or more | 2 or lower |
| EASI 100 | 100% | 0 |
In the NHS. NICE recommends dupilumab for moderate to severe atopic dermatitis in adults when at least one other systemic therapy has not worked or is unsuitable, and says to stop it at 16 weeks if the response is not adequate: at least a 50% fall in EASI (EASI 50) and at least a 4-point fall in the DLQI from when treatment started (NICE TA534).
Change in points. A 2012 analysis of three randomised trials put the minimal clinically important difference for EASI at 6.6 points (Allergy, 2012). The calculator’s Compare with an earlier EASI box shows the change in points and percent and which response level a new score reaches.
Tips for accurate EASI scoring
- Score inflamed skin only. Dry skin (xerosis), ichthyosis, keratosis pilaris, hives and leftover colour changes after eczema are not counted unless active eczema is present.
- Average across the region. If a sign varies, roughly average it across the affected areas only. Half points help here.
- Allow for darker skin. Redness is easy to underestimate on darker skin, where it can look more violet than pink. Assessors often raise the redness grade by one level, and NICE asks clinicians to take skin colour into account when using the EASI.
- Divide each region. Splitting the head and neck into face, scalp and neck (about a third each) makes the area estimate easier.
- Keep the same assessor. When tracking change, the same person scoring each time gives more consistent results.
Tips from the practical guide to the EASI (Dermatitis, 2022) and DermNet.
Limitations of the EASI
- Moderate agreement between assessors. Two people scoring the same skin can differ, which is why the same assessor is advised for repeat scores.
- Extent and severity weigh the same. Widespread mild eczema and patchy severe eczema can produce the same score.
- Lichenification is slow to settle. It is usually the last sign to clear and can hold the score up for weeks after other signs improve.
- Signs only. EASI does not measure itch, sleep or how eczema affects daily life. For psoriasis, the equivalent signs score is the PASI.
EASI and other eczema measures
| Measure | What it scores | Scored by | Key change |
|---|---|---|---|
| EASI | Redness, thickness, scratch marks and lichenification in four regions, 0 to 72 | Clinician | 6.6 points |
| SCORAD | Eczema severity; estimates area with the rule of 9s | Clinician | 8.7 points |
| POEM | Patient-Oriented Eczema Measure | Patient or carer | 3.4 points |
| DLQI | Effect of skin disease on quality of life, 0 to 30 | Patient | 4 points (NICE) |
Key change for EASI, SCORAD (8.2 for objective SCORAD) and POEM is the minimal clinically important difference from Allergy, 2012; for the DLQI it is the fall NICE pairs with EASI 50. For the full family of skin quality of life questionnaires, see our guide to dermatology quality of life questionnaires.
Where the EASI came from
The EASI’s reliability was tested by the EASI Evaluator Group and published in Experimental Dermatology in 2001 (Hanifin and colleagues). 15 dermatologists scored 20 adults and children with atopic dermatitis on two consecutive days. The authors concluded that the EASI “can be learned quickly and utilized reliably” and supported its use in clinical trials of treatments for atopic dermatitis.
The Harmonising Outcome Measures for Eczema (HOME) initiative, based at the University of Nottingham’s Centre of Evidence Based Dermatology, later chose EASI as “the core outcome for measuring the clinical signs of eczema in all trials” (HOME). HOME publishes the official EASI user guide and separate scoring forms for under 8s and for ages 8 and over.
Frequently asked questions
What does EASI stand for?
What does an EASI score mean?
How do I calculate an EASI score?
What does EASI 75 mean?
What EASI score is severe?
What change in EASI score matters?
Is the EASI different for children?
Can I work out my own EASI score?
References
- Hanifin JM, Thurston M, Omoto M, et al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001;10(1):11-8. PubMed 11168575
- Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The Eczema Area and Severity Index: a practical guide. Dermatitis. 2022;33(3):187-192. PMC9154300
- What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study. Br J Dermatol. 2015. PubMed 25580670
- EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012. PubMed 21951293
- Schmitt J, Spuls PI, Thomas KS, et al. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800-807. PubMed 25282560
- NICE. Dupilumab for treating moderate to severe atopic dermatitis (TA534). nice.org.uk
- HOME, University of Nottingham. EASI for clinical signs. homeforeczema.org
- Indirect comparison using the Eczema Area and Severity Index. Acta Derm Venereol. medicaljournals.se
- DermNet. EASI score. dermnetnz.org