Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study

Background Diagnosing atopic dermatitis (AD) in infants is challenging. Objectives To determine the incidence and persistence of eczema and AD in infants using the UK Working Party (UKWP) and Hanifin and Rajka (H&R) criteria. Methods A cohort of 1834 infants was examined clinically at 3, 6 and 12 months of age. AD was diagnosed by UKWP (3, 6 and 12 months) and H&R (12 months) criteria. Logistic regression models were used to assess the relationship between AD and eczema. Results Eczema was observed in 628 (34 center dot 2%) infants (n = 240, n = 359 and n = 329 at 3, 6 and 12 months, respectively), with AD diagnosed in 212 (33 center dot 7%) infants with any eczema and in 64/78 (82%) infants with eczema at all three visits. The odds of AD were lower with first presentation of eczema at 6 [odds ratio (OR) 0 center dot 33, 95% confidence interval (CI) 0 center dot 22-0 center dot 48] or 12 months (OR 0 center dot 49, 95% CI 0 center dot 32-0 center dot 74) than at 3 months, and higher in infants with eczema at three (OR 23 center dot 1, 95% CI 12 center dot 3-43 center dot 6) or two (OR 6 center dot 5, 95% CI 4 center dot 3-9 center dot 9) visits vs. one visit only. At 12 months, 156/329 (47 center dot 4%) fulfilled the UKWP and/or H&R criteria; 27 (8%) fulfilled the UKWP criteria only and 65 (20%) only the H&R criteria. Of the 129 infants who fulfilled the H&R criteria, 44 (34 center dot 1%) did not meet the itch criterion. Conclusions Used in combination and at multiple timepoints, the UKWP and H&R criteria for AD may be useful in clinical research but may have limited value in most other clinical settings.