What are the diagnostic criteria for pediatric atopic dermatitis (AD)?

Updated: Apr 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic criteria for atopic dermatitis (AD) have been proposed by Hanifin and Rajka (1980) and largely adopted by the American Academy of Allergy, Asthma, and Immunology. [17] Appropriate cases must have at least 3 major characteristics and at least 3 minor characteristics.

Major characteristics include the following:

  • Pruritus

  • Typical morphology and distribution (ie, flexural lichenification and linearity in adults, facial and extensor involvement in infants and young children)

  • Chronic or chronically relapsing dermatitis

  • Personal or family history of atopy (eg, asthma, allergic rhinoconjunctivitis, atopic dermatitis)

Minor characteristics are as follows:

  • Xerosis (dry skin)

  • Ichthyosis, palmar hyperlinearity, keratosis pilaris

  • Hand dermatitis, foot dermatitis

  • Cheilitis

  • Nipple eczema

  • Susceptibility to cutaneous infection (eg, with Staphylococcus aureus, herpes simplex virus [HSV], other viruses, warts, molluscum, dermatophytes)

  • Erythroderma

  • Perifollicular accentuation

  • Pityriasis alba

  • Early age of onset

  • Impaired cell-mediated immunity

  • Recurrent conjunctivitis

  • Orbital darkening

  • Infraorbital fold (eg, Dennie pleat, Morgan fold)

  • Anterior neck folds

  • Keratoconus

  • Anterior subcapsular cataracts

  • Sensitivity to emotional factors

  • Food intolerance

  • Pruritus with sweating

  • Intolerance of wool

  • White dermographism

  • Immediate type I skin test response

  • Elevated total serum immunoglobulin E (IgE)

  • Peripheral blood eosinophilia

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