Hanifin and Rajka Diagnostic Criteria for Atopic Dermatitis (AD)

Major criteria: Must have three or more of:

1. Pruritus
2. Typical morphology and distribution

Flexural lichenification or linearity in adults

Facial and extensor involvement in infants and children
3. Chronic or chronically-relapsing dermatitis4. Personal or family history of
atopy (asthma, allergic rhinitis, atopic dermatitis)
Minor criteria: Should have three or more of:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

Xerosis
Ichthyosis, palmar hyperlinearity, or keratosis pilaris
Immediate (type 1) skin-test reactivity
Raised serum IgE
Early age of onset
Tendency toward cutaneous infections (especially S aureus and herpes
simplex) or impaired cell-mediated immunity
Tendency toward non-specific hand or foot dermatitis
Nipple eczema
Cheilitis
Recurrent conjunctivitis
Dennie-Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataracts
Orbital darkening
Facial pallor or facial erythema
Pityriasis alba
Anterior neck folds
Itch when sweating
Intolerance to wool and lipid solvents
Perifollicular accentuation
Food intolerance
Course influenced by environmental or emotional factors
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:
1.
2.

Pruritus
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:

1.
2.
3.

Early age at onset

Atopy (IgE reactivity)
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

1.
2.
3.
4.
5.

Keratosis pilaris/Ichthyosis/Palmar hyperlinearity

Atypical vascular responses
Perifollicular accentuation/Lichenification/Prurigo
Ocular/periorbital changes
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:
1.
2.
3.

Rothe MJ, Grant-Kels JM. Diagnostic criteria for atopic dermatitis. Lancet.
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Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. 1998; 351: 1715-1721.
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Simpson EL, Hanifin JM. Atopic dermatitis. Med Clin North Am. 2006

4.

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Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of
care for the management of atopic dermatitis: section 1. Diagnosis and
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