Atopic Dermatitis Overview of Current Diagnosis

Symptoms and Physical Findings

The main physical findings associated with AD include xerosis, lichenification, and eczematous lesions. Eczematous changes are seen in varying locations, depending on the age of the patient (infant, child, or adult).1

The following symptoms and features are also commonly seen in AD:

  • Prurituis
  • Chronic and relapsing course
  • Early age of onset
  • Peripheral eosinophilia
  • IgE reactivity
  • Staphylococcus aureus superinfection
  • Personal history of asthma or hay fever
  • History of atopic diseases in a first-degree relative1

Diagnosis – American Academy of Dermatology

According to the American Academy of Dermatology,2,3 patients with presumed AD should have their diagnosis based on a combination of features.

Essential Features2,3

(must be present)

Important Features2,3

(support diagnosis; seen in most cases)

·     Prurituis

·     Eczema (acute, subacute, chronic)

·     Typical morphology and age specific patterns*

·     Chronic or relapsing history

*Patterns include:
 1. Facial, neck, and extensor involvement in infants/children
2. Current/previous flexural lesions at any age
3. Sparing of the groin and axillary regions

·  Early age of onset

·  Atopy

·  Personal and/or family history

·  Immunoglobulin E reactivity

·  Xerosis

 

 

“Associated Features” help suggest the diagnosis of AD but are nonspecific.2,3 These include:

  • Atypical vascular responses
  • Keratosis pilaris/ pityriasis alba/ hyperlinear palms/ icthyosis
  • Ocular/periorbital changes
  • Perifollicular accentuation/ lichenification/ prurigo lesions

In addition, other conditions must be excluded, such as: scabies, seborrheic dermatitis, contact dermatitis, icthyoses, cutaneous t-cell lymphoma, psoriasis, photosensitivity dermatoses, immune deficiency diseases, and erythroderma of other causes.2,3

For additional information on diagnosis of AD, we encourage you to visit the following references as well as our “Additional Reading” and “Quick Reference” sections.

References

  1. Kim B. Atopic dermatitis. Available at: https://emedicine.medscape.com/article/1049085-overview
  2. American Academy of Neurology. Atopic dermatitis clinical guideline. Available at: https://www.aad.org/practicecenter/quality/clinical-guidelines/atopic-dermatitis/diagnosis-and-assessment
  3. Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.