The criteria adopted by Hanafin and Rajka do form a benchmark for the diagnosis of atopic dermatitis but, in practice the criteria proposed by the U.K. Working Group(2) is easier to use to arrive at a diagnosis. The criteria go as follows; Itchy skin condition (obligatory); p1us three more of the following: history of flexural involvement, history of asthma/hay fever, history of generalized dry skin, onset of rash under the age of 2 years, or visible flexural dermatitis.

The authors have mentioned that the severe form of atopic dermatitis is rare in India, but, most of the studies that have been cited, come from a single geographical area, and the reason for this is that no validated studies have been published from other parts of India. In practice, one does come across quite severe cases, which require treatment with calcineurin inhibitors like cyclosporin and tacrolimus, or immunosuppresants like azathioprine.

While discussing emollients and cleansers, it would be worthwhile to suggest that the patients avoid the ones containing lanolin, which is a known sensitizer in atopics. The OTC preparations used on babies contain lanolin, albeit the fact that these cosmetics carry no labelling in India. Besides, the physician would well avoid neomycin containing preparations, as neomycin is a known contact sensitizer in atopics.

Rajesh Sankar,
Consultant Dermatologist,
Cochin Hospital,
Kochi, India.

1. Sarkar R, Kanuwar AJ. Atopic dermatitis. Indian Pediatr, 2002; 39: 922-930.

2. Williams HC, Burney PGJ, Pembroke AC, Hay RJ. The U.K. Working Party’s diagnostic crlteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol 1994; 131: 406-416.