Box 171 In order to qualify as a case of atopic eczema the person must have the following6

An itchy skin condition

Plus three or more of:

• Past involvement of the skin creases such as bends of elbows or behind the knees

• Personal or immediate family history of asthma or hay fever

• Tendency towards a generally dry skin

• Onset under the age of 2 years

• Visible flexural dermatitis as defined by a photographic protocol are poorly defined, probably mean something only to dermatologists. Scientifically developed refinements of the Hanifin and Rajka diagnostic criteria, mainly for epidemiological studies, have been developed by a UK working party, and these criteria have been widely used throughout the world.5 These are shown in Box 17.1.6

It is quite possible that there are distinct subsets of atopic eczema, for example those cases associated with atopy and those who have severe disease with recurrent infections. Until the exact genetic and causative agents are known, it is wiser to consider the clinical disease as one condition. Perhaps sensitivity analyses should be done within clinical trials for those who are thought to represent distinct subsets, for example those who are definitely atopic with raised circulating IgE to allergens, and those with severe disease and associated asthma.3

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