Hanifin's and Rajka's minor criteria for atopic dermatitis: Which do 2-year-olds exhibit?

Background: In 1980 Hanifin and Rajka published major and minor criteria fo r atopic dermatitis (AD). Despite the early age at onset of AD, there are f ew prospective studies in young children of the prevalence of signs and sym ptoms meeting the minor criteria. Objective: Our purpose was to identify those of Hanifin's and Rajka's minor criteria that are most frequent in 2-year-old children with AD and in cont rols. Methods: Consecutive patients with AD (n = 221), 24 months of age or younge r, were followed up to 2 years, when they were re-examined. The minor crite ria were divided into 33 subcriteria, 29 of which were examined. Controls ( n = 99), matched for age and sex, with no history of eczema at 2 years of a ge were examined in the same way Results: At the 2-year examination 157 of 221 had ongoing AD. Seven minor c riteria were met in more than one fourth of these children, namely xerosis (100%), course influenced by environmental factors (87%), facial erythema ( 54%), skin reactions provoked by ingested food (39%), itch when sweating (3 4%), positive skin prick test (29%), and hand eczema (28%). In the control group, only xerosis (40%), facial erythema (25%), and skin reactions provok ed by ingested food (9%) were present in 4% or more. Conclusion: Approximately half of the 29 criteria investigated were met in 3% or fewer of the cases, indicating that they may not be of much help to t he clinician. Of the minor criteria of Hanifin and Rajka, only xerosis, cou rse influenced by environmental factors, and facial erythema were seen in a majority of patients and would therefore be useful in the diagnosis of AD.