UK Working Party Criteria
The UK Working Party criteria (Williams et al., BJD 1994) cut the long Hanifin-Rajka Criteria down to a short set that needs no laboratory tests. That makes them usable by GPs, nurses and epidemiologists as well as dermatologists (Healio). A person has Atopic Dermatitis if they have an itchy skin condition (mandatory) plus three or more of five features (Napolitano et al., 2022): (1) onset under age 2; (2) a history of flexural involvement (skin creases); (3) a personal history of asthma or hay fever; (4) generally dry skin in the past year; (5) visible flexural dermatitis. Both these and the Hanifin–Rajka criteria have been validated in a range of populations (Healio; AAD 2014). In drug trials from 2007 to 2016 they were used less than Hanifin–Rajka (9% vs 41%) (Healio, citing Vakharia 2018).
Conflict: [Healio clinical guidance, n.d., citing Williams et al. BJD 1994] dates the UK criteria to 1994. [Napolitano et al., Dermatol Ther, 2022] says they “were introduced by Williams et al.” in 1997. Unresolved — add to open_questions.
UK Working Party Criteria [defines] Atopic Dermatitis UK Working Party Criteria [part-of] Hanifin-Rajka Criteria
Adapting them for toddlers. As written, the original criteria do not fit very young children well (Healio). NICE CG57 therefore uses a version adjusted for age. A child has atopic eczema if they have an itchy skin condition plus three or more of these: visible flexural dermatitis (or, at 18 months or younger, dermatitis on the cheeks and/or extensor surfaces); a history of the same; dry skin in the last 12 months; asthma or allergic rhinitis (or, under age 4, atopic disease in a first-degree relative); and onset before age 2, a criterion not used in children under 4 (NICE CG57). For a 1–4-year-old, then, the onset criterion drops out, and parental or sibling atopy can stand in for the child’s own asthma or hay fever.
NICE CG57 [regulates] UK Working Party Criteria
Limitations. The criteria are built around flexural eczema. In Asian, Black Caribbean and Black African children eczema often affects the extensor surfaces instead, and can be discoid or follicular. NICE CG57 explicitly warns clinicians about this, so a child with skin of colour may fail the “flexural” items despite having AD (see Eczema in Skin of Colour). The criteria also say nothing about severity, which needs a separate tool such as EASI, SCORAD or POEM. Finally, meeting them does not rule out mimics such as scabies or seborrhoeic dermatitis (see Differential Diagnosis of Toddler Eczema). Most guidelines treat an experienced clinician’s judgement as the real gold standard and keep formal criteria mainly for research (Napolitano 2022).
Eczema in Skin of Colour [contradicts] UK Working Party Criteria UK Working Party Criteria [relates] Differential Diagnosis of Toddler Eczema
Connections
- Atopic Dermatitis — defines, source: AAD 2014; NICE CG57
- Hanifin-Rajka Criteria — simplified from, source: Healio; Napolitano 2022
- NICE CG57 — age-adjusted version for under-4s, source: NICE CG57
- Eczema in Skin of Colour — flexural items can miss extensor-pattern AD, source: NICE CG57
- Differential Diagnosis of Toddler Eczema — criteria do not exclude mimics, source: Napolitano 2022
- SCORAD — diagnosis by UK criteria, severity by SCORAD in the Ben-Gashir cohort, source: Ben-Gashir & Hay 2002