Diagnostic Criteria for Atopic Dermatitis (Eczema)

DERMATOLOGY

Pruritus (itchy skin) and xerosis (dry skin) are key symptoms of atopic dermatitis. If a patient doesn’t have them, the diagnosis of eczema should be questioned.

Below, we I share two criteria commonly used. The U.K. Working party is highly validated and has high sensitivity and specificity as shown below.

1. The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis

A simplified version of the U.K. Working Party’s diagnostic criteria for eczema has a sensitivity of 95% and specificity of 97%.

These criteria include itchy skin PLUS at least 3 of the following:

  • History of generalized dry skin
  • History of flexural involvement
  • Visible flexural dermatitis.
  • History of atopy (asthma or allergic rhinitis)–personal or family history
  • The onset of rash before two years of age

2. Hanifin Criteria for Atopic Dermatitis

Major Features (Must Have 3 or more) 

  • Pruritus (itchy skin)
  • Typical morphology and distribution
    1. Facial and extensor involvement during infancy and childhood
    2. Flexural lichenification and linearity in adults
  • Chronic or chronically relapsing dermatitis
  • Personal or family history of atopy (asthma, allergic rhinoconjunctivitis, atopic dermatitis)

Minor or Less-Specific Features 

  • Cheilitis
  • Hand or foot dermatitis
  • Ichthyosis, hyperlinearity, keratosis pilaris
  • Immunoglobulin E (IgE) reactivity (increased serum IgE, radioallergosorbent, or prick test reactivity)
  • Periauricular fissures
  • Perifollicular accentuation (especially in pigmented areas)
  • Scalp dermatitis (cradle cap)
  • Susceptibility to cutaneous infections (especially Staphylococcus aureus and herpes simplex virus)
  • Xerosis

 

Further Reading / Resources

Br J Dermatol. 2001 Sep;145(3):428-33. Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based setting. https://www.ncbi.nlm.nih.gov/pubmed/11531832

Am Fam Physician. 2012 Jul 1;86(1):35-42. Atopic Dermatitis: An Overview.

Br J Dermatol. 1994 Sep;131(3):406-16. The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation. https://www.ncbi.nlm.nih.gov/pubmed/7918017

Hanifin JM: Atopic dermatitis in infants and children. Pediatr Clin North Am. 1991;38:763-789.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/atopic-dermatitis/

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