A PROTOCOL FOR RECORDING THE SIGN OF FLEXURAL DERMATITIS IN CHILDREN

The presence of visible flexural dermatitis is a key feature in diagno sing atopic dermatitis. We describe a protocol for recording this sign in population-based studies, which could be used by suitably trained non-dermatologists. The protocol was developed using a standard set of photographs and accompanying instructions, which define the terms 'de rmatitis' and 'flexural'. When assessed during a survey of skin diseas e in primary schoolchildren, there was excellent agreement between a t rained nurse and a dermatologist with regard to the presence or absenc e of this sign in 73 consecutive children, with perfect agreement in 7 1 children (97%), and a chance corrected agreement index (kappa statis tic) of 0.90 (95% confidence interval [CI] 0.77-0.99). Agreement betwe en two nurses on 114 consecutive schoolchildren was not quite as good, with perfect agreement in 102 children (90%), and a kappa value of 0. 51 (95% CI 0.26-0.77). The protocol is easy to perform, does not requi re children to undress, takes <1 min to carry out, and is highly accep table to children and staff. This protocol may be useful in standardiz ing the assessment of atopic dermatitis in population studies of child ren.