Prominent Pruritic Periumbilical Papules: A Diagnostic Sign in Pediatric Atopic Dermatitis


Address correspondence to Bernard A. Cohen, M.D., Departments of Pediatrics and Dermatology, Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287, or e-mail:


Abstract: Establishment of diagnostic criteria for atopic dermatitis has been a subject of controversy and frequent reevaluation. The diagnostic criteria of Hanifin and Rajka are those most frequently cited. In order to fit the diagnosis, a patient must demonstrate three major criteria plus four or more minor criteria. Although individually the minor criteria are not diagnostic, their presence suggests the possibility of atopic dermatitis. Recently we evaluated several children who developed prominent periumbilical papules as a major component of their atopic dermatitis. This finding, while not present in all children with atopic dermatitis, can provide a specific clue to diagnosis and should be considered as a new minor criterion for atopic dermatitis in children.