• Diagnosis is based on patient history & physical exam
• Investigate exacerbating factors
  • Eg Aeroallergens, foods, irritating chemicals, emotional stress
  • Not very useful clinically

Hanifin & Rajka Criteria for Diagnosis of Atopic Dermatitis

Major Criteria (must have ≥3)

• Pruritus
• Typical morphology & distribution
• Facial & extensor involvement in infants & children
• Dermatitis - chronically or chronically relapsing
• Personal or family history of atopy - asthma, allergic rhinitis, atopic dermatitis

Minor Criteria (must have ≥3)

• Facial features: facial pallor, facial erythema, hypopigmented patches, infraorbital darkening, infraorbital folds (Dennie-Morgan folds), cheilitis, recurrent conjunctivitis, anterior neck folds
• Triggers: foods, emotional factors, environmental factors, skin irritants
• Complications: susceptibility to cutaneous infections, impaired cell-mediated immunity, immediate skin-test reactivity, elevated IgE, keratoconus, anterior subcapsular cataracts
• Others: early age of onset, dry skin, ichthyosis, hyperlinear palms, keratosis pilaris, hand & foot dermatitis, nipple eczema, white dermatographism, perifollicular accentuation

United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis

• Itchy skin condition plus ≥3 of the following:
  • Visible flexural dermatitis w/ involvement of skin creases or on the cheeks & extensor surfaces for infants <18 months old
  • Flexural involvement (eg antecubital & popliteal fossa) or on the cheeks & extensor surfaces for infants <18 months old
  • History of dry skin within the last 12 months
  • Personal history of asthma or allergic rhinitis, or atopic dermatitis in a 1st degree relative if <4 years old
  • Signs & symptoms started when <2 years of age in patients ≥4 years old

Disease Severity

• A holistic approach may be applied when assessing severity of disease

Severity	Skin	Quality of Life & Social Wellbeing
Mild	W/ areas of dry skin, infrequent pruritus w/ or w/o areas of redness	Minimal impact on quality of life (some disturbance during the day & during sleep, mild changes in psychosocial wellbeing)
Moderate	W/ areas of dry skin, frequent pruritus, redness w/ or w/o excoriation & skin thickening	Moderately affects quality of life including everyday activities & psychosocial wellbeing, sleep frequently disrupted
Severe	Extensive areas (>20%) of dry skin, intensely pruritic, erythema w/ or w/o excoriation & skin thickening; often complicated by persistent infections	Significant disruption of quality of life; sleepless nights; lost school days

• Ocular or infectious complications may also be present in severe atopic dermatitis
• May require hospitalization for severe eczema or skin infections
• Severity may also be assessed using different scoring methods (eg SCORing Atopic Dermatitis [SCORAD], Eczema Area & Severity Index [EASI], Patient Oriented Eczema Measure [POEM])