Atopic Dermatitis U.K. Working Party Criteria (1994)

Diagnosis Requires:

• History of an itchy skin condition (or parental report of scratching/rubbing by the child)

PLUS 3 of:

1. History of involvement of skin creases (antecubital, popliteal, anterior ankles, or around the neck) or cheeks in children < age 10 years
2. Personal history of asthma or hay fever (or history of atopic disease in 1st degree relative if < age 4 years)
3. History of generalized dry skin in the past year
4. Visible flexural dermatitis (or eczema on the cheeks/forehead and outer limbs in children < age 4 years)
5. Onset under the age of 2 (do not use as criterion if patient is < age 4 years)

Reprinted with permission from: Williams HC, Burney PG, Hay RJ, 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.

Management

• Elimination of precipitating irritants: Avoid wool and synthetic fabrics; wear cotton clothes, humidifier at home; dietary restriction if specific verified food allergy; stress reduction.
• Skin care: Mild (e.g., Dove®) or no soap or soap substitute (e.g., Cetaphil®, Spectroderm®); mild detergent, double rinse; no bleaches or fabric softeners.
• Skin hydration: Qd to tid baths with emollients (Aveeno® or Alpha Keri oil®), pat dry and apply thick nonfragranced emollient (e.g., Vaseline®, Glaxal Base®, Aquaphor®) immediately after bath.
• Topical steroids: 1% hydrocortisone ointment bid to face and folds, midpotency steroids bid to other affected areas; ointments more occlusive and more effective than creams—use intermittently, for exacerbations.
• Steroid-sparing topical immunomodulators can be used bid in children > 2 yr: Pimecrolimus (Elidel®) cream—mild-moderate eczema. Tacrolimus (Protopic^TM) ungt—moderate-severe eczema.
• Oral antihistamines may offer symptomatic relief of the associated pruritus, e.g., hydroxyzine (3—5 mg/kg/d divided tid/qid).
• If secondarily infected (e.g., impetigo): antibiotic therapy, e.g., topical mupirocin or systemic cloxacillin or cephalexin.
• Other topical Tx options: Burow's solution (acute weeping eczema), tar preparations
• In patients refractory to conventional therapy, other systemic Tx choices include: PUVA or UVB light therapy, systemic steroids (short courses), methotrexate, cyclosporine; usually administered by dermatologist.