Evaluation of Hanifin and Rajka atopic eczema diagnostic guidelines for reduced minor criteria

Different atopic eczema diagnostic guidelines have been proposed for the diagnosis of atopic eczema. But the Hanifin and Rajka major and minor criteria seem to have got a better acceptance internationally. The aim of this study is to select those minor criteria which are most relevant to the Ethiopian situation, and eventually propose them to be used as a standard in Ethiopia.

Using the Hanifin and Rajka (HR) atopic eczema diagnostic guidelines as a gold standard, a total of 119 atopic eczema patients were selected from the diagnostic clinic of ALERT hospital Sensitivities to diagnose atopic eczema were calculated for six subgroups, formed by serially reducing increasing number of minor criteria from the gold standard

When seven and twelve minor criteria are reduced from the Hanifin and Rajka atopic eczema diagnostic guidelines the sensitivities to detect an atopic eczema case were 96.64% and 86.55% respectively. When further criteria were reduced the sensitivities dropped down significantly.

Only nine minor criteria (itching while sweating, course influenced by environmental factors/ emotional stress, Dennie-Morgan infraorbital folds, recurrent conjunctivitis, hand dermatitis, foot dermatitis, white demographismus, facial erythema and pityriasis alba) are the most relevant minor criteria for the diagnosis of atopic eczema in Ethiopia. Xerosis can be taken as one major criterion.