A protocol for recording the sign of flexural dermatitis in children

Br J Dermatol. 1995 Dec;133(6):941-9. doi: 10.1111/j.1365-2133.1995.tb06930.x.


The presence of visible flexural dermatitis is a key feature in diagnosing atopic dermatitis. We describe a protocol for recording this sign in population-based studies, which could be used by suitably trained non-dermatologists. The protocol was developed using a standard set of photographs and accompanying instructions, which define the terms 'dermatitis' and 'flexural'. When assessed during a survey of skin disease in primary schoolchildren, there was excellent agreement between a trained nurse and a dermatologist with regard to the presence or absence of this sign in 73 consecutive children, with perfect agreement in 71 children (97%), and a chance corrected agreement index (kappa statistic) of 0.90 (95% confidence interval [CI] 0.77-0.99). Agreement between two nurses on 114 consecutive schoolchildren was not quite as good, with perfect agreement in 102 children (90%), and a kappa value of 0.51 (95% CI 0.26-0.77). The protocol is easy to perform, does not require children to undress, takes < 1 min to carry out, and is highly acceptable to children and staff. This protocol may be useful in standardizing the assessment of atopic dermatitis in population studies of children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Clinical Protocols
  • Dermatitis, Atopic / pathology*
  • Dermatology / methods
  • Humans
  • Observer Variation
  • Photography
  • Skin / pathology*