Atopic%20dermatitis%20(pediatric) Diagnosis
Diagnosis
- Diagnosis is based on patient history and physical exam
- Investigate exacerbating factors
- Eg Aeroallergens, foods, irritating chemicals, emotional stress
- Not very useful clinically
Classification
Hanifin and Rajka Criteria for Diagnosis of Atopic Dermatitis
Major Criteria (must have ≥3)
- Pruritus
- Typical morphology and distribution
- Facial and extensor involvement in infants and children
- Dermatitis - chronically or chronically relapsing
- Personal or family history of atopy - asthma, allergic rhinitis, atopic dermatitis
Minor Criteria (must have ≥3)
- Facial features: Facial pallor, facial erythema, hypopigmented patches, infraorbital darkening, infraorbital folds (Dennie-Morgan folds), cheilitis, recurrent conjunctivitis, anterior neck folds
- Triggers: Foods, emotional factors, environmental factors, skin irritants
- Complications: Susceptibility to cutaneous infections, impaired cell-mediated immunity, immediate skin-test reactivity, elevated IgE, keratoconus, anterior subcapsular cataracts
- Others: Early age of onset, dry skin, ichthyosis, hyperlinear palms, keratosis pilaris, hand and foot dermatitis, nipple eczema, white dermatographism, perifollicular accentuation
United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis
- Itchy skin condition plus ≥3 of the following:
- Visible flexural dermatitis with involvement of skin creases or on the cheeks and extensor surfaces for infants <18 months old
- Flexural involvement (eg antecubital and popliteal fossa) or on the cheeks and extensor surfaces for infants <18 months old
- History of dry skin within the last 12 months
- Personal history of asthma or allergic rhinitis, or atopic dermatitis in a 1st degree relative if <4 years old
- Signs and symptoms started when <2 years of age in patients ≥4 years old
Evaluation
Disease Severity
- A holistic approach may be applied when assessing severity of disease
Severity | Skin | Quality of Life and Social Wellbeing |
Mild | With areas of dry skin, infrequent pruritus with or without areas of redness | Minimal impact on quality of life (some disturbance during the day and during sleep, mild changes in psychosocial wellbeing) |
Moderate | With areas of dry skin, frequent pruritus, redness with or without excoriation and skin thickening | Moderately affects quality of life including everyday activities and psychosocial wellbeing, sleep frequently disrupted |
Severe | Extensive areas (>20%) of dry skin, intensely pruritic, erythema with or without excoriation and skin thickening; often complicated by persistent infections | Significant disruption of quality of life; sleepless nights; lost school days |
- Ocular or infectious complications may also be present in severe atopic dermatitis
- May require hospitalization for severe eczema or skin infections
- Severity may also be assessed using different scoring methods (eg SCORing Atopic Dermatitis [SCORAD], Eczema Area and Severity Index [EASI], Patient Oriented Eczema Measure [POEM])