Observer's protocol for recording the sign of
"visible flexural dermatitis"

A. Subjects aged 4 years and over

Your task is to record as consistently as possible the presence/absence
of physical signs - "visible flexural dermatitis".

To decide whether this sign is present or not, there are two components to consider:

Step 1 What dermatitis looks like

Definition of dermatitis: Poorly demarcated erythma (redness) with surface change
"Surface change" can mean fine scaling, vesicles, oozing, crusting or lichenification.

Here are some photographs to help you. Click on the photograph for a larger image.

Protocol picture 1 shows dermatitis

1. This is dermatitis. Note it is red, has an indistinct margin and there is a surface change (in this case fine scaling)

Protocol picture 4 shows lichenification

4. This is lichenification in a white skin. lichenification means a thickening of the skin in response to scratching. The skin markings are exaggerated and the skin feels thickened.

Protocol picture 2 showing oozing and crusting

2. This is dermatitis showing another type of surface change, in this case oozing (clear fluid leaking from the skin) and crusting (scabs).

Protocol picture 5 showing lichenification in a black skin

5. This is lichenification in a black skin. Note the exaggerated skin creases and post-inflammatory pigmentation

Protocol picture 3 showing vesicles

3. These are vesicles (tiny clear "water" blisters).

Protocol picture 6 showing follicular lichenification

6. This is also lichenification in a black skin. In this case, the thickening is comprised of smaller flat topped bumps corresponding to hair follicles - so called "follicular lichenification".