Abstract
The United Kingdom Working Party's (UKWP) criteria were developed to improve epidemiological research in atopic dermatitis (AD), but have not been validated in an exclusively adult European population. To validate the UKWP criteria for AD in adults. In this cross-sectional study, three independent samples of adult individuals were drawn and interviewed: patients with a hospital diagnosis of AD or plaque psoriasis in adulthood, and general population controls. Various versions of the UKWP criteria for AD were utilized. A total of 3490 (general population), 3834 (AD) and 4016 (psoriasis) adult individuals were enrolled in the study. The best combination of the UKWP criteria leads to a sensitivity of 0.71 and a specificity of 0.96 in the general population. The criteria better captured 'AD ever' compared with 'AD within the past 12months' and had a higher sensitivity in patients with moderate (87.2-97.7%) or severe (95.8-100%) AD at the time of interview compared with those who where asymptomatic (12.6-36.8%). The UKWP criteria also captured high proportions of psoriasis patients (19.7-47.7%) when applied in a cohort of unique psoriasis patients. It remains a challenge to accurately diagnose a history of AD in adulthood since symptoms are shared with other skin conditions and AD may have resolved or can be waxing and waning, in turn leading to recall bias. The UKWP criteria performed well in the general population for the purpose of determining the prevalence, but should be used cautiously when studying comorbidity.
Highlights
Atopic dermatitis (AD) is a prevalent inflammatory skin condition of childhood and adulthood..The 1980 Hanifin and Rajka (H&R) criteria were developed to better delineate AD patients for clinical and investigative studies and avoid misclassification.[1]
Some criteria were predominately derived from clinical features observed in AD patients with European ancestry,[2] and expectedly, their performance is less good in non-European populations.[3]
The cohort was generated based on 3 independent samples, respectively, i) 10,000 adults from the general population sample randomly drawn from the general Danish population (CPR register) with no diagnostic code of psoriasis or AD in the hospital system, ii) 10,000 adult patients with a diagnostic code for AD, and iii) 10,000 adult patients with a diagnostic code for plaque psoriasis randomly drawn from the National Patient Registry.[18]
Summary
The 1980 Hanifin and Rajka (H&R) criteria were developed to better delineate AD patients for clinical and investigative studies and avoid misclassification.[1] some criteria proved to be either unspecific or occur very infrequently. To improve epidemiological research in AD, the United Kingdom Working Party’s (UKWP) Criteria for AD were developed in 1994, using the original Hanifin and Rajka criteria as a starting point. The UKWP criteria were validated in groups of predominately pediatric patients with AD as well as healthy controls, and patients with other inflammatory skin conditions.[2, 8, 9] Based on these studies, six features were identified that could reliably separate predominately pediatric AD from other inflammatory skin conditions (Table 1). The major criterion, itch, was selected as it was considered very sensitive, whereas the minor criteria were selected as they were considered to be specific.[8]
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