Atopic Dermatitis: A Review of Current Diagnostic Criteria and a Proposed Update to Management

March 2020 | Volume 19 | Issue 3 | Original Article | 244 | Copyright © March 2020


Published online February 4, 2020

Matthew Reynolds , Joe Gorelick , Matthew Bruno

aArkansas Dermatology and Skin Cancer Center, Little Rock, AR bCalifornia Skin Institute, San Jose, CA cDermatology and Skin Cancer Surgery Center, Allen, TX







criteria be met along with at least 3 of 23 minor criteria. The major criteria are pruritus, typical morphology and distribution of the condition (ie, facial and extensor involvement in children; lichenification of flexural areas in adults), a chronic relapsing course, and a personal or family history of atopy. Validation studies of the Hanifin–Rajka criteria report sensitivity and specificity ranges of 87.9% to 96% and 77.6% to 93.8%, respectively.9 Refinements of the Hanifin–Rajka criteria have been made over the years. Some reports have disputed the diagnostic significance of some of the 23 minor criteria,10 while others have suggested that additional features should be included and that >3 minor features are normally present in a confirmed diagnosis. 11

United Kingdom (UK) Working Party Criteria
Outside of the hospital environment, the Hanifin–Rajka criteria are difficult to interpret by the average dermatologist or primary care practitioner, which can result in inaccuracies in diagnosis and/or further treatment delays. Recognition of this led to the establishment of the UK Working Party criteria in 1994,