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December 1999

Diagnostic Criteria for Atopic Dermatitis: Consider the Context

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Arch Dermatol. 1999;135(12):1551. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-12-dlt1299

I am writing in response to the May 1999 article1 and editorial2 in the ARCHIVES about diagnostic criteria for atopic dermatitis (AD). Having been one of the first proponents of diagnostic criteria for AD, I feel a need to make some clarifying comments before we are completely lost in muddy waters. Seeking some assurance that different groups were studying the same disease, Dr Lobitz and I first laid out diagnostic guidelines for AD in a 1977 article.3 The more well-known criteria evolved further during an active discussion at the First International Symposium on Atopic Dermatitis in 1979.4 These criteria were too complex for population-based screening, and Williams et al5 performed a service by deriving a minimum set of discriminators for epidemiologic use. The editorial by Williams2 is a good analysis of a problem that Firooz et al1 have uncovered. Until there is a precise laboratory marker, we are dependent on obviously imprecise clinical criteria. We must constantly remember that these criteria are imprecise; no amount of mathematical, statistical manipulation or validation will make them precise, and we should not be disheartened if a study does not validate them.