dermatologic disorders
Atopic Dermatitis (Eczema)
Diagnosis of Atopic Dermatitis
Clinical evaluation Diagnosis of atopic dermatitis is clinical. History (eg, personal or family history of allergic rhinoconjunctivitis, seasonal or perennial; asthma) is helpful. See tablefor the modified clinically relevantguidelines of care for the diagnosis and assessment of atopic dermatitis(2014) from the American Academy of Dermatology. Atopic dermatitis is sometimes difficult to differentiate from other dermatoses. The diagnosis of atopic dermatitis depends on excluding other conditions, such as the following ( Diagnosis reference ): Seborrheic Dermatitis None Contact Dermatitis (irritant or allergic) Psoriasis None Nummular Dermatitis None Scabies None Ichthyosis None Cutaneous T-cell Lymphomas (CTCL) None Photosensitivity dermatoses Immune deficiency diseases Erythroderma of other causes Although a personal and/or family history of atopy and the distribution of lesions are helpful in making the diagnosis of atopic dermatits, the following distribution patterns can help with differentiation: Psoriasis is typically easy to recognize by its sharply demarcated, thick, erythematous, and scaly plaques. It is usually extensoral rather than flexural and may include typical nail findings not common in atopic dermatitis (eg, oil spots,). most commonly affects the face (eg, nasolabial folds, eyebrows, glabellar region, scalp). Nummular dermatitis is not flexural, and lichenification is rare. (However,can occur in atopic dermatitis [nummular atopic dermatitis].) Erythroderma caused by atopic dermatitis can be difficult to differentiate from erythroderma caused by other skin disorders. Clues to atopic dermatitis include a flexural distribution of lesions and personal or family history of allergic rhinoconjunctivitis and asthma. There is no definitive laboratory test for atopic dermatitis. However, testing for type I allergies (prick, scratch, and intracutaneous testing or measurement of allergen-specific IgE levels and of total IgE levels) can help confirm atopic diathesis. Cultures forS. aureusare not done routinely but can help determine sensitivities to systemic antimicrobials when impetiginization is suspected (eg, with yellowish crusts). 1.Eichenfield LF, Tom WL, Chamlin SL, et al: Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis.J Am Acad Dermatol70(2):338–351, 2014. doi: 10.1016/j.jaad.2013.10.010 