Hanifin and Rajka, in 1980, based on their clinical studies and experience, proposed certain diagnostic criteria for atopic dermatitis to differentiate atopic eczema from other types of eczemas. These include major and minor criteria.
Major Criteria for Diagnosis of Atopic Dermatitis
For atopic eczema to be diagnosed, at least 3 or more of the following major criteria should be present, in addition to 3 or more of the minor criteria.
- Itching.
- Typical dermatitis (eczema), which has a history of relapses.
- Typical distribution of the skin rashes: Facial and outer aspect of arms and legs in infants and children, and lichenifed (thickened skin with increased skin markings) rashes on the flexural (bending) areas of the body like elbows, behind knees etc.
- The patient or any of the family members suffering from atopy (allergic diseases) like asthma, nasal allergy or atopic eczema.
Minor Criteria for Diagnosis of Atopic Dermatitis
In addition to three major criteria, 3 or more of the following minor criteria should also be present.
- Dry skin.
- Cataract: Anterior subcapsular- Due to application of steroids near eyes?
- Lip Dermatitis.
- Recurrent eye inflammation (red eye) and irritation.
- Face: Pale, red.
- Food intolerance.
- Hand eczema.
- Elevated Immunoglobulin E (IgE) levels.
- Immediate type 1 skin test reactivity.
- Recurrent infections.
- Itching on sweating.
- Pityriasis alba: White patches on the face and exposed area, showing mild scaling.
- White dermographism: Skin, on stroking, becomes white and raised, instead of the red line in normal people.
- Keratoconus: Cone shaped cornea seen between 20-40 years of age in very severe cases of atopic eczema.
- Others like Keratosis pilaris (hair follicle oriented hard bumps), nipple dermatitis, dark eye circles, wool intolerance, linear marks on the palms etc are additional features that may be considered as minor criteria.
The Drawbacks of the Diagnostic Criteria of Atopic Dermatitis
Though the major criteria are found consistently in atopic eczema, the minor criteria are non specific and seen in other conditions as well. Though many dermatologists found these criteria useful, it has not been validated against clinical diagnosis and reproducibility tests.
To address the above drawbacks, William et al coordinated a UK working group to refine these criteria so that these can be applied to a wide setting of population groups of all age groups and ethnicity.
The Modified Criteria for Atopic Dermatitis
In order for a child to be diagnosed with atopic eczema, the child must have:
- An itchy skin condition (or parents reporting scratching or rubbing in a child).
Plus three or more of the following:
- Onset of itching and eczema below the age of 2 years (If child is below 4 years, this criteria not used).
- History of skin fold involvement, including cheeks in children below the age of 10 years.
- Presence of dry skin.
- Personal history of other atopic disease like asthma, nasal allergy or history of atopic illness in a first degree relative of children under 4 years.
- Visible flexural dermatitis, or dermatitis of cheeks, forehead and outer limbs in children below 4 years age.
These modified criteria have simplified the diagnosis of atopic dermatitis in the general population and is to be welcomed.
Reference
- Hanifin JM, Rajka RG. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stock) 1980; 92(Suppl.144) 44-7.
- Atopic Dermatitis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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