Validation of diagnostic criteria for atopic dermatitis and proposal of novel diagnostic criteria for adult and elderly Chinese populations: a multicentre, prospective, clinical setting-based study

Abstract

Background A previous validation study showed a very low sensitivity and higher specificity associated with Hanifin and Rajka criteria (H&R) and the UK Working Party criteria (UKWP) in diagnosing AD vs. the Chinese criteria of atopic dermatitis (AD) for children (CCAD). However, their diagnostic efficacy in adult and elderly Chinese populations remains unknown. Objectives To validate the diagnostic efficacy of three sets of AD criteria in adult and elderly Chinese populations in a hospital setting. Methods A total of 1034 patients (aged 19–95 years) from five university hospital dermatological clinics were recruited. Medical history, dermatological examination, AD diagnosis and evaluation of AD severity were done by dermatologists. Each patient was investigated by two dermatologist panels, one to establish a clinical diagnosis, and the other to identify and record the major or minor signs of H&R criteria, UKWP criteria and CCAD. Taking clinical diagnosis as the reference, the diagnostic efficacy of three sets of diagnostic criteria was evaluated. The χ2 test or rank sum test were used for between-groups comparisons. Results CCAD had a higher sensitivity (84.0%), especially among mild and moderate cases of AD (72.7% and 90.3%, respectively), than the H&R (58.0%; P < 0.001) and UKWP criteria (56.0%; P < 0.001) in diagnosing AD. The specificity of CCAD (92.7%) was slightly lower than the H&R (97.3%; P < 0.001) or UKWP criteria (97.4%; P < 0.001). The CCAD had the highest Youden index (0.77), accuracy rate (0.90) and Kappa value (0.76) of the three sets of diagnostic criteria. Conclusions Consistent with results in a population of Chinese children, although the H&R and UKWP criteria had a high specificity for diagnosing AD, their low sensitivity limited their use in adult and elderly Chinese patients. Based on the high sensitivity and favourable diagnostic efficacy, the CCAD is proposed for AD diagnosis in adult and elderly Chinese populations, especially for cases of mild and moderate AD.

Development and validation of diagnostic criteria for elderly atopic dermatitis

“…14 Some studies have explored the diagnosis of elderly AD. Chello et al 22 suggested a set of clinical and serological criteria that might be able to guide the diagnosis of AD in elderly Caucasian; Yue et al 23 applied the “Chinese criteria of AD for children” to assess the diagnostic sensitivity and specificity for adult and elderly AD, and found that its sensitivity was significantly higher than the H.R. criteria and UKWP criteria, while the specificity decreased.…”

Screening mitochondria-related biomarkers in skin and plasma of atopic dermatitis patients by bioinformatics analysis and machine learning

“…57 participants (AD, n=38; healthy control, HC, n=19)were recruited from the Dermatology Department of the Second Affiliated Hospital of Harbin Medical University, Harbin, China. The Chinese criteria ( 20 , 21 ) was used to diagnose AD participants, and the Eczema Area and Severity Index (EASI) criteria was used to assess the degree of clinical symptoms. Healthy subjects were defined by a lack of history of visible signs of skin damage that is indicative of AD.…”

Atopic Dermatitis in the Elderly Population

“…In particular, Chinese criteria for adult and adolescent AD point to the mandatory presence of persistent or recurrent symmetrical eczema for more than 6 months. In addition, one or more of the following elements are necessary for the diagnosis: personal and/or family history of atopic diseases; elevated total serum IgE levels and/or positive allergen-specific IgE and/or eosinophilia ( 23 , 24 ) . Japanese criteria consider AD as a chronic disease characterized by fluctuating phases of remitting and relapsing eczema with pruritus as a primary symptom.…”