Evaluation of Hanifin and Rajka atopic eczema diagnostic guidelines for reduced minor criteria.

BACKGROUND: Different atopic eczema diagnostic guidelines have been proposed for the diagnosis of atopic eczema. But the Hanifin and Rajka major and minor criteria seem to have got a better acceptance internationally. The aim of this study is to select those minor criteria which are most relevant to the Ethiopian situation, and eventually propose them to be used as a standard in Ethiopia. METHODS: Using the Hanifin and Rajka (HR) atopic eczema diagnostic guidelines as a gold standard, a total of 119 atopic eczema patients were selected from the diagnostic clinic of ALERT hospital Sensitivities to diagnose atopic eczema were calculated for six subgroups, formed by serially reducing increasing number of minor criteria from the gold standard RESULTS: When seven and twelve minor criteria are reduced from the Hanifin and Rajka atopic eczema diagnostic guidelines the sensitivities to detect an atopic eczema case were 96.64% and 86.55% respectively. When further criteria were reduced the sensitivities dropped down significantly. CONCLUSIONS: Only nine minor criteria (itching while sweating, course influenced by environmental factors/ emotional stress, Dennie-Morgan infraorbital folds, recurrent conjunctivitis, hand dermatitis, foot dermatitis, white demographismus, facial erythema and pityriasis alba) are the most relevant minor criteria for the diagnosis of atopic eczema in Ethiopia. Xerosis can be taken as one major criterion.

Patch test reaction on Ethiopian subjects with eczema.

BACKGROUND: Allergic contact dermatitis is a common condition with an incidence of 1-10% in the general population. An increasing number of allergens in the environment are responsible for the condition. These allergens can be identified using patch testing. Many countries have a standard series of common allergens used for patch testing. There is no standard series of allergens in Ethiopia, and our objective was to obtain baseline data for common allergens for future standardization. METHODS: One hundred and eighty-one subjects with eczema were patch tested using 17 selected allergens from Chemotechnique Diagnostics AB employing a standard procedure. RESULTS: Positive patch test reactions were detected in more than 60% of subjects, the most common allergen being nickel, followed by fragrance mix and butylphenolformaldehyde. A higher incidence of positive reactions was seen in females. CONCLUSIONS: A high incidence of positive patch test reactions was identified in the study population, and the introduction of patch testing in Ethiopia is essential for the management of allergic contact dermatitis.