Development and validation of diagnostic criteria for elderly atopic dermatitis

Objective: Elderly atopic dermatitis (AD) is a newly identified subtype of AD. Whether specific diagnostic criteria are needed for elderly AD has been debated. This study aimed to propose diagnostic criteria for elderly AD and evaluate the sensitivity. Methods: A hospital-based study was conducted. We screened the clinical features of 1312 patients with AD of different ages in one cohort and proposed a set of diagnostic criteria for elderly AD. The criteria were then validated in another cohort of 223 patients clinically diagnosed with elderly AD by dermatologists specialized in AD to examine the diagnostic sensitivity compared with other criteria by chi-square test. Results: Based on the patients’ clinical features, a set of diagnostic criteria for elderly AD were proposed. The new diagnostic criteria showed significantly higher sensitivity than the classical diagnostic criteria (P<0.001), especially for mild and moderate AD (P<0.001）. Of all 223 patients with elderly AD, 93.3% fulfilled our criteria, while only 43.5%, 65.5%, and 52.0% fulfilled the Hanifin and Rajka criteria, the Japanese Dermatology Academy criteria, and the United Kingdom Working Party criteria, respectively. Conclusion: The newly proposed criteria for elderly AD yielded high diagnostic sensitivity, particularly for mild and moderate AD.