PASI, EASI, SCORAD, or DLQI — Which Dermatology Score to Use and When

Why severity scoring matters in dermatology

Dermatology is one of the few specialties where disease severity is almost entirely subjective without standardised scoring tools. Two dermatologists examining the same patient can reach different conclusions about whether psoriasis is "moderate" or "severe" — and that distinction determines whether a patient qualifies for biologic therapy, whether an insurance claim will be approved, and whether a treatment switch is clinically justified.

Using validated, reproducible scoring systems transforms subjective impressions into objective data. Trending scores across visits tells you whether a treatment is working — not just your impression, but a number.

PASI — Psoriasis Area and Severity Index

Use for: Plaque psoriasis. The gold standard for clinical trials and biologic pre-authorisation. What it measures: Four body regions (head, trunk, upper limbs, lower limbs) are each scored for erythema, induration, and desquamation (each 0–4), then multiplied by the body surface area involved in that region (0–6) and by a regional body area weighting factor. Maximum score is 72. Key thresholds:

• PASI < 10: Mild disease
• PASI 10–20: Moderate disease
• PASI > 20: Severe disease

Biologic threshold in Egypt: Most payers require PASI ≥ 10 plus DLQI > 10 for biologic approval. Some require PASI ≥ 12 for second-line biologics. Treatment response definitions:

• PASI 50: 50% reduction from baseline — minimum response criterion
• PASI 75: 75% reduction — the historical benchmark for psoriasis trials
• PASI 90: 90% reduction — the modern standard for biologic efficacy
• PASI 100: Complete clearance — achievable with IL-17 and IL-23 inhibitors

EASI — Eczema Area and Severity Index

Use for: Atopic dermatitis (eczema). The equivalent of PASI for eczema, used in clinical trials of dupilumab and other biologics. What it measures: Four body regions scored for four clinical signs — erythema, oedema/papulation, excoriation, and lichenification — each on a 0–3 scale. Multiplied by the affected area per region and regional weighting. Maximum score is 72. Key thresholds:

• EASI 0: Clear
• EASI 1–7: Mild
• EASI 7–21: Moderate
• EASI > 21: Severe

Treatment response: EASI 50, EASI 75, and EASI 90 are used in the same way as PASI response criteria.

SCORAD — SCORing Atopic Dermatitis

Use for: Atopic dermatitis — provides more comprehensive information than EASI by including patient-reported symptoms (itch and sleep disturbance). What it measures: Combines extent of affected BSA (A, max 100), intensity of six signs — redness, oedema, oozing/crusting, excoriation, lichenification, dryness — (B, max 18), and subjective symptoms of itch and sleep loss (C, max 20). Formula: A/5 + 7B/2 + C. Maximum score is 103. Key thresholds:

• < 25: Mild
• 25–50: Moderate
• > 50: Severe

When to use SCORAD vs EASI: Use SCORAD in clinical practice and in children when the sleep and itch dimensions are important for treatment decisions. Use EASI when participating in clinical trials or when comparing with published biologic efficacy data.

DLQI — Dermatology Life Quality Index

Use for: Any inflammatory skin condition. Measures quality of life impact, not clinical severity. Essential for biologic pre-authorisation alongside PASI or EASI. What it measures: 10 questions covering symptoms, daily activities, leisure, work/school, personal relationships, and treatment over the past week. Each scored 0–3. Maximum 30. Key thresholds:

• 0–1: No effect on quality of life
• 2–5: Small effect
• 6–10: Moderate effect
• 11–20: Very large effect
• 21–30: Extremely large effect

Biologic threshold: DLQI > 10 is the standard cut-off used alongside PASI ≥ 10 to demonstrate that disease has a significant impact on quality of life — required by most Egyptian payers for biologic approval.

Which score to use — a practical guide

Recommended score --- PASI + DLQI PASI ≥ 10 AND DLQI > 10 SCORAD EASI + DLQI VASI

Clinical situation
	---
	Psoriasis — any severity
	Psoriasis — biologic pre-authorisation
	Atopic dermatitis — clinical practice
	Atopic dermatitis — dupilumab audit
	Vitiligo
	Urticaria

UAS7 |

Trending scores across visits

The real power of these tools comes from trending, not from a single measurement. A patient whose PASI drops from 24 to 6 over 16 weeks of methotrexate has achieved PASI 75 — a clinically meaningful response that justifies continuing the treatment. A patient whose PASI drops from 24 to 20 after 16 weeks has not achieved PASI 50 — a signal to reassess the treatment plan.

In Clinit's dermatology module, you enter scores at each visit and the trend chart is generated automatically. Treatment events (start date, dose changes, interruptions) are overlaid on the trend so you can see the treatment-response relationship at a glance. DLQI trends are shown alongside clinical scores on the same chart.

Documentation for insurance and audit

When submitting for biologic pre-authorisation, your documentation should include:

• Baseline PASI and DLQI scores with dates
• Evidence of adequate trial of conventional therapy (methotrexate, cyclosporine, acitretin) for ≥ 3 months
• Reason for discontinuation or inadequate response to conventional therapy
• Photographs at baseline and at the most recent assessment
• Current PASI and DLQI scores at the time of submission

Clinit generates a formatted pre-authorisation summary from the severity score history, clinical notes, and before/after photos — reducing the time spent on insurance paperwork from 30 minutes to under 5.