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
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- 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:
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Xerosis
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Ichthyosis, palmar hyperlinearity, or keratosis pilaris
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Immediate (type 1) skin-test reactivity
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Raised serum IgE
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Early age of onset
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Tendency toward cutaneous infections (especially S aureus and herpes simplex) or impaired cell-mediated immunity
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Tendency toward non-specific hand or foot dermatitis
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Nipple eczema
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Cheilitis
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Recurrent conjunctivitis
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Dennie-Morgan infraorbital fold
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Keratoconus
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Anterior subcapsular cataracts
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Orbital darkening
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Facial pallor or facial erythema
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Pityriasis alba
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Anterior neck folds
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Itch when sweating
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Intolerance to wool and lipid solvents
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Perifollicular accentuation
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Food intolerance
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Course influenced by environmental or emotional factors
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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:
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Pruritus
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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:
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Early age at onset
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Atopy (IgE reactivity)
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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
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Keratosis pilaris/Ichthyosis/Palmar hyperlinearity
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Atypical vascular responses
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Perifollicular accentuation/Lichenification/Prurigo
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Ocular/periorbital changes
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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.
References:
- Rothe MJ, Grant-Kels JM. Diagnostic criteria for atopic dermatitis. Lancet. 1996; 348: 769-770. [Medline]
- Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. 1998; 351: 1715-1721. [Medline]
- Simpson EL, Hanifin JM. Atopic dermatitis. Med Clin North Am. 2006 Jan;90(1):149-67 [Medline]
- 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]
- 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]
- Ständer S. Atopic Dermatitis. N Engl J Med. 2021 Mar 25;384(12):1136-1143. [Medline]
Update: Jul 27, 2021.
