Diagnostic criteria for atopic dermatitis: a systematic review

BACKGROUND: Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations and despite various validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition. Nevertheless, clinical studies require valid diagnostic criteria for reliable and reproducible results. OBJECTIVE: To summarize the evidence concerning the validity of diagnostic criteria for AD. METHODS: All data sources were identified through searches on Medline, Embase and Cochrane databases. The Quality Assessment of Diagnostic Accuracy tool (QUADAS) was used. Results are presented in a receiver operating characteristic (ROC) plot. RESULTS: Out of the 20 articles that met the criteria, 27 validation studies were identified. In two studies concerning Hanifin and Rajka diagnostic criteria sensitivity and specificity ranged from 87.9% to 96.0% and from 77.6% to 93.8%, respectively. Nineteen validation studies of the U.K. diagnostic criteria showed sensitivity and specificity ranging from 10% to 100% and 89.3% to 99.1%, respectively. Three validation studies concerning the Schultz-Larsen criteria showed sensitivity from 88% to 94.4% and specificity from 77.6% to 95.9%. In one article concerning the criteria of Diepgen, the sensitivity ranged from 83.0% to 87.7% and the specificity from 83.9% to 87.0%. One article studied the Kang and Tian criteria and reported 95.5% sensitivity and 100% specificity. One article validating the International Study of Asthma and Allergies in Childhood (ISAAC) criteria showed a positive and negative predictive value of 48.8% and 91.1%, respectively. CONCLUSION: With this systematic review of the existing sets of diagnostic criteria for AD a varying number of validation studies with varying methodological quality was found. The U.K. diagnostic criteria are the most extensively validated. However, improvement of methodological design for validation studies and uniformity in well-validated and applicable diagnostic criteria are needed to improve future intervention studies and to compare study results.     

Comparative efficacy of Hanifin and Rajka''s criteria and the UK working party''s diagnostic criteria in diagnosis of atopic dermatitis in a hospital setting in North India

BACKGROUND: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital-based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity. AIM AND OBJECTIVE: This study was undertaken to validate Hanifin and Rajka's criteria and to assess the comparative efficacy of their criteria and the UK working party's diagnostic criteria in the diagnosis of AD in a hospital setting in North India. SUBJECTS AND METHODS: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004. RESULTS: Hanifin and Rajka's criteria (sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%) had a statistical advantage over the UK working party's diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P-value < 0.005.     

特应性皮炎临床特点和诊断标准的探讨

目的 探讨康克非和田润梅提出的特应性皮炎(AD)诊断标准(简称康田标准)的适用性。方法 用康田标准对917例经Hanifin和Rajka诊断标准(简称HR标准)确诊的AD患者进行诊断,并分析AD患者的遗传过敏史及其临床特点。结果 888例AD患者符合康田标准,占96.84%.有个人或家族过敏史者占83.21%.婴儿期AD患者面部皮炎的发生率高于儿童期和青少年、成人期,而其干皮症、鱼鳞病、毛周角化、眶周黑晕的发生率又低于儿童期和青少年、成人期。结论 遗传过敏史是AD诊断中的一个重要因素。康田标准是一个合理实用的诊断标准,值得推广使用。     

Validation and refinement of the Millennium Criteria for atopic dermatitis

There is no gold standard for a definite diagnosis of atopic dermatitis. For the time being, several lists of diagnostic criteria have been proposed, some of them in actual use. The Millennium Criteria have been proposed to diagnose atopic dermatitis and to differentiate it from atopiform dermatitis. Our aim was to further refine the Millennium Criteria into a manageable set that can differentiate between atopic and atopiform dermatitis and other entities. The hereby refined Millennium Criteria will be compared with the UK Working Party Criteria and the Hanifin & Rajka Criteria. Data of 210 included patients were used. After multiple logistic regression, a minimum set of five criteria was identified as best discriminators: (i) typical morphology; (ii) early age of onset; (iii) Dennie-Morgan fold; (iv) historical and (v) actual flexural involvement. The refined Millennium Criteria were constituted from these criteria. When comparing the different list for validity in diagnosing atopic dermatitis, the refined Millennium Criteria showed a sensitivity of 81.8% and a specificity of 98.8% compared to a sensitivity of 97.7% and specificity of 72.9% of the UK Criteria and a sensitivity of 100% and specificity of 48.8% of the Hanifin & Rajka Criteria. This refinement and validity study shows that the refined Millennium Criteria are a valid tool to diagnose atopic and atopiform dermatitis in a hospital-based setting and therefore could be incorporated in clinical practice and trials.     

特应性皮炎张氏诊断标准在苏南地区青少年和成人的适用性评估

【摘要】 目的 评估特应性皮炎（AD）张氏诊断标准在苏南地区青少年和成人的适用性。方法 收集2019年5月至2021年5月来自苏南地区7家医院皮肤科初诊为湿疹或AD的病例1 769例。由研究人员自行设计调查表,主要包括患者的个人信息、相关病史及临床特征、实验室检查等内容,由患者和皮肤科医生共同完成标准化问卷。以Hanifin-Rajka标准为金标准,分别评估Williams标准、张氏标准、日本皮肤病学会标准的敏感性和特异性。结果 1 769例患者中男759例（42.9%）,女1 010例（57.1%）,年龄（32.2 ± 8.2）岁（12 ~ 79岁）。AD患者的临床特征中瘙痒的发生率占首位（96.7%,883/913）。以Hanifin-Rajka标准为“金标准”,913例（51.6%）被诊断为AD;张氏标准诊断敏感性为92.6%（845/913）,特异性为73.2%（627/856）;Williams标准诊断敏感性为87.8%（802/913）,特异性为81.3%（696/856）;JDA标准敏感性为96.9%（885/913）,特异性为68.9%（590/856）。张氏标准与Williams标准诊断一致性一般（Kappa值 = 0.61,P = 0.009）,张氏标准与JDA标准诊断一致性高（Kappa值 = 0.85,P = 0.001）,Williams标准与JDA标准诊断一致性一般（Kappa值 = 0.51,P = 0.013）。结论 与Hanifin-Rajka标准相比,张氏标准对于苏南地区青少年和成人AD的诊断表现出良好的敏感性和特异性,但瘙痒对AD的诊断亦非常重要。     

Assessment of the American Academy of Dermatology diagnostic criteria for pediatric atopic dermatitis and modification into a checkbox form: A cross-sectional study

Background/Objectives

Diagnostic criteria for atopic dermatitis (AD) are limited in their performance and/or usability. The American Academy of Dermatology (AAD) consensus criteria include hierarchical categories of disease features to improve these metrics but have not been validated. Our objective was to create and validate a checkbox form of the AAD consensus criteria in the pediatric population.

Methods

We performed a cross-sectional study of 100 pediatric patients with AD (n = 58) and diseases in the differential diagnosis of AD (n = 42).

Results

Having three or more “Essential,” ≥2 “Important,” ≥1 “Associated” features of the AAD criteria was optimal for the diagnosis of AD in children. This combination was 91.4% (95% CI, 84.2%–98.6%) sensitive and 95.2% (88.8%–100%) specific. The UK working party criteria and the Hanifin–Rajka criteria had sensitivities of 96.6% (95% CI 91.9%–100%) and 98.3% (95% CI 94.9%–100%) and specificities of 83.3% (95% CI 72.1%–94.6%) and 71.4% (95% CI 57.8%–85.1%), respectively. The AAD criteria had significantly greater specificity than the Hanifin–Rajka criteria (p = .002).

Conclusions

This study represents an important step in validating the AAD consensus criteria and formulating a useable checkbox form for diagnosing AD in the pediatric population.     

A comparison between criteria for diagnosing atopic eczema in infants

BACKGROUND: Epidemiological studies have shown different estimates of the frequency of atopic eczema (AE) in children. This may be explained by several factors including variations in the definition of AE, study design, age of study group, and the possibility of a changed perception of atopic diseases. The role of IgE sensitization in AE is a matter of debate. OBJECTIVES: To determine the prevalence and cumulative incidence of AE in a group of unselected infants followed prospectively from birth to 18 months of age using different diagnostic criteria; to evaluate the agreement between criteria; and to describe the association between atopic heredity and postnatal sensitization, respectively, and the development of AE according to the different diagnostic criteria. METHODS: During a 1-year period a consecutive series of 1095 newborns and their parents were approached at the maternity ward at the Odense University Hospital, Denmark and a cohort of 562 newborns was established. Infants were examined and followed prospectively from birth and at 3, 6, 9, 12 and 18 months of age. AE was diagnosed using four different criteria, the Hanifin and Rajka criteria, the Schultz-Larsen criteria, the Danish Allergy Research Centre (DARC) criteria developed for this study and doctor-diagnosed visible eczema with typical morphology and atopic distribution. Additionally, the U.K. diagnostic criteria based on a questionnaire were used at 1 year of age. Agreement between the four criteria was analysed at each time point and over time, and agreement between the four criteria and the U.K. questionnaire criteria was analysed. RESULTS: The cumulative 1-year prevalence of AE using the Hanifin and Rajka criteria was 9.8% (95% confidence interval, CI 7-13%), for the Schultz-Larsen criteria it was 7.5% (95% CI 5-10%), for the DARC criteria 8.2% (95% CI 6-11%), for visible eczema 12.2% (95% CI 9-16%) and for the U.K. criteria 7.5% (95% CI 5-10%). The pairwise agreement between criteria showed good agreement, with rates varying between 93% and 97% and kappa scores between 0.6 and 0.8. Agreement analysis of diagnoses between the four criteria demonstrated that cumulative incidences showed better agreement than point prevalence values. CONCLUSIONS: Agreement between different criteria for diagnosing AE was acceptable, but the mild cases constituted a diagnostic problem, although they were in the minority. Repeated examinations gave better agreement between diagnostic criteria than just one examination. Atopic heredity was less predictive for AE than sensitization to common food and inhalant allergens in early childhood.     

Community validation of the United Kingdom diagnostic criteria for atopic dermatitis in Romanian schoolchildren

Although the U.K. modification of Hanifin and Rajka's diagnostic criteria for atopic dermatitis (AD) for use in epidemiological studies has demonstrated good validity and repeatability when previously tested in a U.K. community setting, little is known about its performance in other countries where different cultural, educational and linguistic factors could impair validity. We used a questionnaire to test the validity of the U.K. criteria as a point prevalence measure of AD in 1114 Romanian schoolchildren aged 6–12 years against the clinical diagnosis of a dermatologist with an interest in AD, who was unaware of the questionnaire content and responses. The sensitivity and specificity of the U.K. criteria for AD in this setting was 74% and 99%, respectively, an improvement rather than a deterioration in validity when compared with the previous U.K. study. Test–retest repeatability for all of the questions pertaining to the U.K. criteria using the chance-corrected kappa statistic was high, with values of 0.72 and over. The positive predictive value of the criteria was lower than in the U.K. study (63% compared with 80%, respectively) due to the very low prevalence of AD in this study (2.4%). The validity of a parental report of 'eczema' was poor, with a sensitivity of 22%, specificity of 97% and positive predictive value of 18%. This study suggests that the U.K. criteria perform well in settings outside the U.K., although care has to be taken when using the criteria to ascertain cases in settings where the prevalence of AD is very low.     

Prominent pruritic periumbilical papules: A diagnostic sign in pediatric atopic dermatitis

Establishment of diagnostic criteria for atopic dermatitis has been a subject of controversy and frequent reevaluation. The diagnostic criteria of Hanifin and Rajka are those most frequently cited. In order to fit the diagnosis, a patient must demonstrate three major criteria plus four or more minor criteria. Although individually the minor criteria are not diagnostic, their presence suggests the possibility of atopic dermatitis. Recently we evaluated several children who developed prominent periumbilical papules as a major component of their atopic dermatitis. This finding, while not present in all children with atopic dermatitis, can provide a specific clue to diagnosis and should be considered as a new minor criterion for atopic dermatitis in children.     

Differenzialdiagnose des atopischen Ekzems in der Kindheit

Atopic eczema (AE) is a chronic inflammatory skin disease which affects 10 to 20% of children and 1 to 3% of adults. AE is usually diagnosed based on standard criteria such as those of Hanifin and Rajka, whereby the age-related variation must be considered. There are numerous other diseases which go along with AE or show a very similar clinical picture and represent important differential diagnostic considerations including parasitic diseases, immunodeficiency, nutritional diseases, certain neoplastic disorders and various corneal abnormalites. Additionally, it is important to consider diseases which can occur in association with AE, such as keratosis pilaris, alopecia areata or sweat disturbances.     

Associated diseases and differential diagnostic considerations in childhood atopic eczema

Atopic eczema (AE) is a chronic inflammatory skin disease which affects 10 to 20% of children and 1 to 3% of adults. AE is usually diagnosed based on standard criteria such as those of Hanifin and Rajka, whereby the age-related variation must be considered. There are numerous other diseases which go along with AE or show a very similar clinical picture and represent important differential diagnostic considerations including parasitic diseases, immunodeficiency, nutritional diseases, certain neoplastic disorders and various corneal abnormalities. Additionally, it is important to consider diseases which can occur in association with AE, such as keratosis pilaris, alopecia areata or sweat disturbances.     

Validation of the diagnostic criteria for atopic dermatitis.

OBJECTIVE: To validate the accuracy of newly proposed diagnostic criteria for atopic dermatitis (AD). DESIGN: Double-blind, cross-sectional study comparing the achievement of new criteria with the diagnosis of a dermatologist. SETTING: A private, general dermatology, outpatient clinic. PATIENTS: A sample of 416 consecutive patients attending the clinic within 2 months (146 males and 270 females), consisting of 60 patients with AD and 356 control patients with other skin diseases. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of proposed criteria in the diagnosis of AD. RESULTS: Sensitivity, specificity, and positive and negative predictive values of proposed diagnostic criteria for AD were 10.0% (95% confidence interval [CI], 4.1%-21.2%), 98.3% (95% CI, 96.2%-99.3%), 50.0% (95% CI, 22.3%-77.7%), and 86.6% (95% CI, 82.8%-89.7%), respectively. CONCLUSIONS: These diagnostic criteria for AD are highly specific and are suitable for clinical trials. However, they may not achieve enough sensitivity to be useful for large, population-based epidemiological studies or for routine clinical practice, at least in Iran.     

Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting

Summary One reason why so little is known about the epidemiology of atopic dermatitis (AD) is lack of suitable diagnostic criteria. A simple list of diagnostic criteria for AD for use in epidemiological studies has recently been developed by a U.K. working party. These have performed well in hospital validation studies of subjects with skin diseases. This study sought to validate the newly proposed criteria for AD in a population setting by conducting a cross-sectional survey of 695 schoolchildren aged 3–11 years in three randomly selected primary schools in West Lambeth, London. As a point prevalence measure, the U.K. criteria had a sensitivity of 70%, a specificity of 93%, and a positive predictive value of 47% when compared with a dermatologist's examination findings. Subsequent analysis suggested that most children classified as false positives had suffered from AD in the last year, but were inactive at the time of examination. When adjusted for these cases, the sensitivity and specificity increased to 80 and 97%, respectively, corresponding to positive and negative predictive values of 80 and 97%, respectively. The U.K. diagnostic criteria for AD appear to work well as a 1-year period prevalence measure in London schoolchildren. Further validation in adults and other countries are needed.     

The millennium criteria for the diagnosis of atopic dermatitis

Abstract: Atopic dermatitis forms an active area of basic and clinical research, where important new knowledge about genetics and immunopathogenesis has surfaced over the past years, and where simultaneous development of new and innovative therapies is under way. However, the inclusion of any patient in an atopic dermatitis study, whether it is on its genetics, pathogenesis or therapy, requires a diagnosis which is irrefutable. Since there is no simple and also no complicated laboratory procedure to reach a diagnosis of atopic dermatitis, different sets of clinical criteria have been developed for the purpose of making the diagnosis uniformly in different studies as well as in different study centers. The most commonly used are Hanifin and Rajka's set of diagnostic features, which have major and minor clinical criteria to be fulfilled in order to establish a diagnosis of atopic dermatitis. Recent developments in the immunology of atopy have clearly established the major abnormality in this syndrome, the preferential production of allergen-specific IgE. In this contribution, it is suggested that the presence of such antibodies in a given patient should be a mandatory criterium for the diagnosis of atopic dermatitis. Such a diagnostic test however establishes a diagnosis of atopic syndrome, not atopic dermatitis. Thus, for atopic dermatitis we have to rely, for the time being, on additional clinical criteria. The clinical features described in the literature are critically evaluated, and it is suggested that in addition to the mandatory presence of allergen-specific IgE, 2 of 3 principal criteria (pruritus, typical morphology and distribution, chronic or chronically relapsing) should be present for such a diagnosis. Finally, the minor features originally described by Hanifin and Rajka and later evaluated by others are revised and divided over 4 subcategories; a) related to subclinical eczema; b) related to dry skin; c) extra skin folds; and d) ophthalmological pathology. They are suggested to be used as additional criteria only, needed when clinical suspicion is high but the new mandatory and principal diagnositic criteria described here are inconclusive. For study purposes, we suggest that the mandatory and principal criteria are sufficient. They are now evaluated and validated in ongoing atopic dermatitis treatment studies.     

特应性皮炎临床特征及诊断标准评估：基于2000—2020年165例住院患者的回顾性分析

【摘要】 目的 分析和总结特应性皮炎（AD）患者临床特点,探讨Williams、日本和中国AD诊断标准的满足情况及差异。方法 回顾性分析陆军军医大学西南医院2000年10月至2020年5月期间根据Williams标准或中国张氏标准确诊的165例特应性皮炎住院患者病历资料。采用Williams、日本和中国AD诊断标准重新评估,比较不同标准之间的差异。计量资料组间比较采用t检验、方差分析或秩和检验;计数资料组间比较采用卡方检验或Fisher确切概率检验。结果 165例AD患者中,66例（40.00%）2岁之前发病;95例（57.58%）伴有个人和/或家族特应性疾病史,其中75例伴有个人特应性疾病史,最常见的是过敏性鼻炎（28.48%）、哮喘（20.00%）,50例伴有家族特应性疾病史,30例同时伴有个人和家族特应性疾病史。98例（59.39%）对尘螨过敏,其中Ⅵ级过敏48例。外源性AD 130例（78.79%）,内源性AD 35例（21.21%）,两组发病年龄、嗜酸性粒细胞计数差异均有统计学意义（均P < 0.001）。满足Williams标准142例（86.06%）,不满足者23例,两组之间发病年龄差异有统计学意义（P = 0.007）;满足中国张氏标准150例（90.91%）,不满足者15例,两组之间嗜酸性粒细胞计数差异有统计学意义（P = 0.001）;满足中国姚氏标准160例（96.97%）;全部满足日本标准。满足Williams标准、日本标准、张氏标准和姚氏标准的患者之间发病年龄、嗜酸性粒细胞计数、总IgE水平差异均无统计学意义（P > 0.05）。结论 早期发病的AD更易合并最高级别的尘螨过敏;外源性AD较内源性AD患者发病年龄更低,嗜酸性粒细胞计数更高;满足Williams标准的患者较不满足的患者发病年龄更低,满足中国张氏标准的患者较不满足的患者嗜酸性粒细胞计数更高。     

Qualitative vs. quantitative atopic dermatitis criteria – in historical and present perspectives

This review summarizes historical aspects, clinical expression and pathophysiology leading to coining of the terms atopy and atopic dermatitis, current diagnostic criteria and further explore the possibility of developing quantitative diagnostic criteria of atopic dermatitis (AD) based on the importance of atopic features – subjective, objective, and those derived from laboratory tests – the new partly promising AD biomarkers. ‘Atopy’, introduced in 1923, denoted ‘the sense of a strange disease without a precise place in the body’. A decade later, Sulzberger and Hill, first defined ‘atopic dermatitis’. The pioneering well‐recognized criteria, ‘Hanifin & Rajka’ (Acta Derm Venereol, 92 , 1980, 44), were developed empirically on ‘clinical experience’ and expert consensus. As opposed to the widely used, rather anamnestic ‘UK Criteria’ (1994), they have few formal validation studies, but appear to well embrace various atopic phenotypes. Pruritus, xerosis, typical morphology/distribution of dermatitis and tendency to a relapsing/chronic course are common basic features in AD criteria, whereas skin sensitivity, heredity and various ill‐defined atopic stigmata also seem to comprise the atopic phenomenon. Specific pheno‐ and endotypes are now emerging potentially enabling us to better classify patients with AD, but the influence of these on the diagnosis of AD is so far unclear. Few diagnostic models use quantitative scoring systems to establish AD cases from normal population, which, however, may be useful to better study and manage this disease. Long‐term prospective observational studies, from which few are available at this point, along with interventional studies, are a perquisite and will provide the best option to improve our understanding of its complex characteristics and etiology.     

The role of Dermatophagoides pteronyssinus in atopic dermatitis

The role of Dermatophagoides (D.) pteronyssinus in atopic dermatitis (AD) was investigated by use of skin prick test (SPT) and total and specific IgE (RAST) to D. pteronyssinus. The study included 43 patients (17 male and 26 female), mean age 42.3 (range 19-77) years. All study patients met the Hanifin and Rajka criteria. Patients were divided into two groups: "pure" AD (n=27; 12 male and 15 female), mean age 46.3 (range 19-77) years; and AD with respiratory symptoms (AD+RS, n=16; 5 male and 11 female), mean age 38.4 (range 17-75) years. Control group consisted of 15 healthy subjects (7 male and 8 female; mean age 49.0, range 24-64 years), with no personal or family history and signs of atopy. Both patient groups had a higher total serum IgE than control subjects (p<0.05). In the "pure" AD group, SPT was positive in 5/27 (18.5%) and RAST to D. pteronyssinus in 4/27 patients. In the AD+RS group, SPT was positive in 10/16 (62.5%) and RAST to D. pteronyssinus in 8/16 (50%) patients. Concordance between SPT and RAST was observed in both groups; 80% of SPT positive patients were RAST positive. D. pteronyssinus was found to play an important role as a trigger factor in AD patients.     

对Moll Wright关节病型银屑病诊断标准的初步评价

目的:评价关节病型银屑病"Moll和Wright"诊断标准的敏感性与特异性.方法:对伴脊柱关节症状和/或体征的银屑病患者按Moll和Wright标准诊断关节病型银屑病,并与"金标准"诊断结果比较.结果:79例银屑病患者纳入研究,按Moll和Wright标准诊断关节病型银屑病43例;按"金标准"确诊61例.Moll和Wright标准的敏感性为67%,特异性为89%.结论:Moll和Wright标准敏感性和特异性较差,今后需对包括影像学指标在内的新的诊断标准进行研究.     

Heterogeneity of atopic dermatitis defined by the immune response to inhalant and food allergens.

Although atopic dermatitis (AD) is a common disease, its etiopathogenesis is not well known. The diagnosis of AD is based solely on the clinical criteria proposed by Hanifin and Rajka. In order to understand the immunological mechanisms involved in the pathogenesis of AD, we have classified the patients affected by this disease in four groups according to the results of skin prick-tests, specific IgE and patch-tests. This classification is intended to separate and compare the patients affected by AD according to the involvement of immunological type I and/or type IV mechanisms. Our results show that, although all the patients studied are clinically affected by AD, there are four different groups of patients who present an apparently diverse immunopathological mechanism. There is a group that seems to have an IgE mediated mechanism, another group that suggests a cell mediated mechanism, another group which seems to involve both mechanisms, and yet another group that apparently does not show any of the above mentioned mechanisms. In the present article we hypothesize and argue that the imbalance of the immune system is a consequence of the still unknown etiopathogenetic mechanism of AD, but perhaps not the cause of AD.     

Clinical features of atopic dermatitis in a hospital‐based setting in China

Background Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. There have been few detailed reports of the clinical evaluation of Chinese patients with AD. Objectives To give a profile of the clinical features of Chinese AD patients in a university hospital setting. Methods A total of 1008 cases met Hanifin and Rajka diagnostic criteria of AD were recruited at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China. Results In our survey, 22.7% patients were mild, 66.6% were moderate and 10.7% were severe according to the SCORAD index. Both the frequency and severity of the male patients were slightly higher. The frequency of asthma among the AD patients was 16.7% and it was increased with the age (χ² = 205.20, P = 0.000). The frequencies of objective minor signs were demonstrated with age‐related changes. Besides, three localized variants including eyelid eczema (49.8%), scalp dermatitis (49.7%), infra‐auricular and retroauricular fissuring (44.8%) were commonly observed, especially in the infantile phase (P < 0.01). It was showed significant differences in serum total immunoglobulin E (IgE) and eosinophil cationic protein (ECP) levels of different age groups. The positive rate of Phadiatop was raised after 3 years old and that of the common food allergens were decreased after 6 years old. Conclusions More males than females had ongoing AD in our survey. Most AD debuted in the first year of the cases. High incidence of the three clinical signs: eyelid eczema, scalp dermatitis and infra‐auricular and retroauricular fissuring among the patients suggests it can be a potential valuable diagnostic clue to AD.