Infraorbital Crease, Ethnic Group, and Atopic Dermatitis

Background and Design: The usefulness of a prominent infraorbital skin crease as a marker of atopic dermatitis (AD) was examined in 160 consecutive children aged 3 to 11 years in a population setting of a primary school in London, England. Infraorbital crease was recorded by two trained observers according to a strict protocol, and AD was determined by an independent dermatologist who was blinded to the study design. Results: A prominent infraorbital crease was present in only four (27%) of 15 children with AD, compared with 49 (34%) of 145 children who did not have AD ( P =.80). A prominent crease was a common finding in black children, even in the absence of AD, affecting 49% (34/69) of normal black children and 25% (11/44) of white children ( P =.02). Interobserver agreement for the presence of infraorbital crease was low, with a κ value of 0.38 (95% confidence interval, 0.23 to 0.53). Conclusions: While infraorbital crease may be of some use in diagnosing individual cases of AD in a hospital setting, it may be less useful in population-based studies because of its poor validity and repeatability. Studies that still use this sign as an indication of allergy need to take ethnic group differences into account. (Arch Dermatol. 1996;132:51-54)