Diagnostic criteria of atopic dermatitis by Hanifin and Rajka, UK Working Party, Japanese Dermatological Association, and Chinese guidelines for adolescent/adults
Hanifin and Rajka criteria
UK Working Party
Japanese Dermatological Association guidelines
Chinese guidelines (adolescents/adults)
Major features:
Typical morphology and distribution: flexural lichenification or linearity in adults. Facial and extensor involvement in infants and children
Chronic or chronically relapsing dermatitis
Personal or family history of atopy (asthma, allergic rhinitis, atopic dermatitis)
Tendency towards nonspecific hand or foot dermatitis
Nipple eczema
Cheilitis
Recurrent conjunctivitis
Dennie-Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataracts
Orbital darkening
Facial pallor/erythema
Pityriasis alba
Anterior neck folds
Itch when sweating
Intolerance to wool and lipid solvents
Food intolerance
Course influenced by environmental/emotional factors
White dermographism/delayed blanch
Major feature:
Itchy skin condition
Minor features:
History of asthma/hay fever
History of generalised dry skin
Onset of rash under the age of 2 years
Visible flexural dermatitis
Diagnosis: major plus three or more of the minor features
Major features:
Pruritus
Typical morphology and distribution
Chronic or chronically relapsing course
Diagnosis:
All above features must be present for more than 2 months in infancy and more than 6 months in childhood, adolescence, and adulthood.
Major feature:
Symmetrical eczema (dermatitis) for more than 6 months
Minor features:
Personal and/or family history of atopic diseases
Elevated total serum IgE level and/or positive allergen specific IgE and/or eosinophilia
Diagnosis: major plus one or more of the minor features
Declarations
Acknowledgments
We wish to acknowledge the financial support received from the Institution-based Research grant of the Nigerian Tertiary Education Trust Fund, the nursing and record staff of the dermatology clinic, and the patients who gave consent to participate in this study.
Author contributions
PUI: Conceptualization, Investigation, Writing—original draft, Writing—review & editing, Funding acquisition. EE: Conceptualization, Investigation, Writing—original draft. TO: Investigation, Writing—review & editing. PB and BAU: Validation, Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
The atopic dermatitis in adults: prevalence, clinical pattern and contact sensitization study protocol was reviewed and approved by the University of Abuja Teaching Hospital Health Research Ethics Committee, approval number: UATH/HREC/PR/2020/016/008 and was conducted in full conformance with the principles of the “Declaration of Helsinki”, Good Clinical Practice (GCP), and the laws and regulations of Nigeria.
Consent to participate
A signed, written informed consent was obtained from each study participant.
Consent to publication
Not applicable.
Availability of data and materials
The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservations, to any qualified researcher.
Funding
This work was conducted with funding received from the Institution-based Research grant of the Nigerian Tertiary Education Trust Fund. The fund was used in the collection of the data. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: Results from an international survey.Allergy. 2018;73:1284–93. [DOI] [PubMed]
Maspero J, Rubini NDPM, Zhang J, Sanclemente G, Amador JR, Sayed MHE, et al. Epidemiology of adult patients with atopic dermatitis in AWARE 1: A second international survey.World Allergy Organ J. 2023;16:100724. [DOI] [PubMed] [PMC]
Nnoruka EN. Current epidemiology of atopic dermatitis in south-eastern Nigeria.Int J Dermatol. 2004;43:739–44. [DOI] [PubMed]
Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis.Acta Derm Venereol Suppl (Stockh). 1980;92:44–7. [DOI]
Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, et al. The U.K. Working Party’s diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis.Br J Dermatol. 1994;131:383–96. [DOI] [PubMed]
Saeki H, Furue M, Furukawa F, Hide M, Ohtsuki M, Katayama I, et al. Guidelines for management of atopic dermatitis.J Dermatol. 2009;36:563–77. [DOI] [PubMed]
Liu P, Zhao Y, Mu Z, Lu Q, Zhang L, Yao X, et al. Clinical features of adult/adolescent atopic dermatitis and Chinese criteria for atopic dermatitis.Chin Med J (Engl). 2016;129:757–62. [DOI] [PubMed] [PMC]
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al.; European Dermatology Forum (EDF); the European Academy of Dermatology and Venereology (EADV); the European Academy of Allergy and Clinical Immunology (EAACI); the European Task Force on Atopic Dermatitis (ETFAD); European Federation of Allergy and Airways Diseases Patients’ Associations (EFA); the European Society for Dermatology and Psychiatry (ESDaP), et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.J Eur Acad Dermatol Venereol. 2018;32:657–82. [DOI] [PubMed]
Hamann CR, Hamann D, Egeberg A, Johansen JD, Silverberg J, Thyssen JP. Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis.J Am Acad Dermatol. 2017;77:70–8. [DOI] [PubMed]
Ibekwe PU, Ukonu BA. Prevalence of atopic dermatitis in Nigeria: a systematic review and Meta-analysis.Nig J Dermatol. 2021;11:7–17.
Dutta A, De A, Das S, Banerjee S, Kar C, Dhar S. A cross-sectional evaluation of the usefulness of the minor features of Hanifin and Rajka diagnostic criteria for the diagnosis of atopic dermatitis in the pediatric population.Indian J Dermatol. 2021;66:583–90. [DOI] [PubMed] [PMC]
Faye O, N’Djong APM, Diadie S, Coniquet S, Niamba PA, Atadokpede F, et al. Validation of the Patient-Oriented SCORing for Atopic Dermatitis tool for black skin.J Eur Acad Dermatol Venereol. 2020;34:795–9. [DOI] [PubMed] [PMC]
Caffarelli C, Dondi A, Dascola CP, Ricci G. Skin prick test to foods in childhood atopic eczema: pros and cons.Ital J Pediatr. 2013;39:48. [DOI] [PubMed] [PMC]
Ibekwe PU, Ibekwe TS. Skin prick test analysis in allergic rhinitis patients: a preliminary study in Abuja, Nigeria.J Allergy (Cairo). 2016;2016:3219104. [DOI] [PubMed] [PMC]
Ibekwe PU, Ekop E, Otu T, Bassi P, Ukonu BA. Patch tests in children with active atopic dermatitis: a prospective study and review of the significance of European baseline series to the African region.Curr Allergy Clin Immunol. 2023;36:100–5.
Sendrasoa FA, Ramily SL, Razafimaharo TI, Ranaivo IM, Andrianarison M, Raharolahy O, et al. Atopic dermatitis in adults: a cross-sectional study in the department of dermatology, Antananarivo, Madagascar.JAAD Int. 2021;4:28–31. [DOI] [PubMed] [PMC]
Pefura-Yone EW, Sonkoue LD, Balkissou AD, Djenabou A. Prévalence et déterminants de la dermatite atopique chez les adultes en population générale dans un pays d’Afrique sub-saharienne.Rev Fr Allergol. 2017;57:240–1. French. [DOI]
Kiiski V, Salava A, Susitaival P, Barnhill S, Remitz A, Heliovaara M. Atopic dermatitis in adults: a population-based study in Finland.Int J Dermatol. 2022;61:324–30. [DOI] [PubMed]
Chan LN, Magyari A, Ye M, Al-Alusi NA, Langan SM, Margolis D, et al. The epidemiology of atopic dermatitis in older adults: a population-based study in the United Kingdom.PLoS One. 2021;16:e0258219. [DOI] [PubMed] [PMC]
Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis.J Am Acad Dermatol. 2019;80:1526–32.e7. [DOI] [PubMed]
Visitsunthorn N, Sripramong C, Bunnag C, Jirapongsananuruk O. Comparison between specific IgE levels and skin prick test results of local and imported American cockroach, dog, cat, dust mites and mold allergen extracts.Asian Pac J Allergy Immunol. 2017;35:60–5. [DOI] [PubMed]
Dey D, Mondal P, Laha A, Sarkar T, Moitra S, Bhattacharyya S, et al. Sensitization to common aeroallergens in the atopic population of West Bengal, India: an investigation by skin prick test.Int Arch Allergy Immunol. 2019;178:60–5. [DOI] [PubMed]
Krämer U, Lemmen C, Bartusel E, Link E, Ring J, Behrendt H. Current eczema in children is related to Der f 1 exposure but not to Der p 1 exposure.Br J Dermatol. 2006;154:99–105. [DOI] [PubMed]
Teplitsky V, Mumcuoglu KY, Babai I, Dalal I, Cohen R, Tanay A. House dust mites on skin, clothes, and bedding of atopic dermatitis patients.Int J Dermatol. 2008;47:790–5. [DOI] [PubMed]
Gutgesell C, Heise S, Seubert S, Seubert A, Domhof S, Brunner E, et al. Double-blind placebo-controlled house dust mite control measures in adult patients with atopic dermatitis.Br J Dermatol. 2001;145:70–4. [DOI] [PubMed]
Gutgesell C, Seubert A, Junghans V, Neumann C. Inverse correlation of domestic exposure to Dermatophagoides pteronyssinus antigen patch test reactivity in patients with atopic dermatitis.Clin Exp Allergy. 1999;29:920–5. [DOI] [PubMed]
Kim J, Lee S, Woo S, Han Y, Lee JH, Lee I, et al. The indoor level of house dust mite allergen is associated with severity of atopic dermatitis in children.J Korean Med Sci. 2013;28:74–9. [DOI] [PubMed] [PMC]
Wang X, Shi X, Li L, Zhou P, Shen Y, Song Q. Prevalence and clinical features of adult atopic dermatitis in tertiary hospitals of China.Medicine (Baltimore). 2017;96:e6317. [DOI] [PubMed] [PMC]
Arruda LK, Yang AC, Aoki V, Criado RF, Pires MC, Lupi O, et al. Clinical features and disease management in adult patients with atopic dermatitis receiving care at reference hospitals in Brazil: the ADAPT study.J Investig Allergol Clin Immunol. 2021;31:236–45. [DOI] [PubMed]
Ibekwe PU, Bagudu ZS. Patch test results obtained with the European baseline series at a diagnostics centre in Abuja, Nigeria.Contact Dermatitis. 2019;81:154–5. [DOI] [PubMed]
Clemmensen KKB, Thomsen SF, Jemec GBE, Agner T. Pattern of contact sensitization in patients with and without atopic dermatitis in a hospital-based clinical database.Contact Dermatitis. 2014;71:75–81. [DOI] [PubMed]
Nedorost ST, Babineau D. Patch testing in atopic dermatitis.Dermatitis. 2010;21:251–4. [DOI]