Unifying Concepts

Diagnostic Criteria for Atopic Dermatitis (AD)

Atopic dermatitis (AD) is an eczematous, highly pruritic chronic inflammatory skin disease. It usually begins early in life and often occurs in people with a personal or family history of asthma and allergic rhinitis.

Hanifin and Rajka Diagnostic Criteria for Atopic Dermatitis (AD)

Major criteria: Must have three or more of:

1. Pruritus
2. Typical morphology and distribution

    • Flexural lichenification or linearity in adults
    • Facial and extensor involvement in infants and children

3. Chronic or chronically-relapsing dermatitis
4. Personal or family history of atopy (asthma, allergic rhinitis, atopic dermatitis)

Minor criteria: Should have three or more of:

  1. Xerosis

  2. Ichthyosis, palmar hyperlinearity, or keratosis pilaris

  3. Immediate (type 1) skin-test reactivity

  4. Raised serum IgE

  5. Early age of onset

  6. Tendency toward cutaneous infections (especially S aureus and herpes simplex) or impaired cell-mediated immunity

  7. Tendency toward non-specific hand or foot dermatitis

  8. Nipple eczema

  9. Cheilitis

  10. Recurrent conjunctivitis

  11. Dennie-Morgan infraorbital fold

  12. Keratoconus

  13. Anterior subcapsular cataracts

  14. Orbital darkening

  15. Facial pallor or facial erythema

  16. Pityriasis alba

  17. Anterior neck folds

  18. Itch when sweating

  19. Intolerance to wool and lipid solvents

  20. Perifollicular accentuation

  21. Food intolerance

  22. Course influenced by environmental or emotional factors

  23. White dermographism or delayed blanch

Suggested Universal Criteria for Atopic Dermatitis (AD) by American Academy of Dermatology

A. Essential features; must be present and, if complete, are sufficient for diagnosis:

  1. Pruritus

  2. Eczematous changes that are acute, subacute, or chronic:

a. Typical and age-specific patterns

(i) Facial, neck, and extensor involvement in infants and children

(ii) Current or prior flexural lesions in adults/any age

(iii) Sparing of groin and axillary regions

b. Chronic or relapsing course

B. Important features that are seen in most cases, adding support to the diagnosis:

  1. Early age at onset

  2. Atopy (IgE reactivity)

  3. Xerosis

C. Associated features: Clinical associations; help in suggesting the diagnosis of AD but are too nonspecific to be used for defining or detecting AD for research and epidemiologic studies

  1. Keratosis pilaris/Ichthyosis/Palmar hyperlinearity

  2. Atypical vascular responses

  3. Perifollicular accentuation/Lichenification/Prurigo

  4. Ocular/periorbital changes

  5. Perioral/periauricular lesions

D. Exclusions: Firm diagnosis of AD depends on excluding conditions such as scabies, allergic contact dermatitis, seborrheic dermatitis, cutaneous lymphoma, ichthyoses, psoriasis, and other primary disease entities.



  1. Rothe MJ, Grant-Kels JM. Diagnostic criteria for atopic dermatitis. Lancet. 1996; 348: 769-770. [Medline]
  2. Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. 1998; 351: 1715-1721. [Medline]
  3. Simpson EL, Hanifin JM. Atopic dermatitis. Med Clin North Am. 2006 Jan;90(1):149-67 [Medline]
  4. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. [Medline]
  5. Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, Shimojo N, Tanaka A, Nakahara T, Nagao M, Hide M, Fujita Y, Fujisawa T, Futamura M, Masuda K, Murota H, Yamamoto-Hanada K; Committee for Clinical Practice Guidelines for the Management of Atopic Dermatitis 2018, The Japanese Society of Allergology, The Japanese Dermatology Association. Japanese guidelines for atopic dermatitis 2020. Allergol Int. 2020 Jul;69(3):356-369. [Medline]
  6. Ständer S. Atopic Dermatitis. N Engl J Med. 2021 Mar 25;384(12):1136-1143. [Medline]


Update: Jul 27, 2021.

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