Atopic%20dermatitis Diagnosis
Diagnosis
- Diagnosis is based on patient's history, cutaneous findings (atopic stigmata), and physical exam
- Investigate exacerbating factors
- Eg Aeroallergens, foods, irritating chemicals, emotional stress, extreme temperature
- Identify and eliminate trigger factors
- Identify potential allergens by careful history and selective allergy tests
- Skin prick tests and serum tests for allergen-specific IgE are only useful if there is a suspected allergen
- Negative results are useful for ruling out suspected allergens
- In vitro allergy tests or positive skin prick tests do not always correlate with clinical symptoms (especially foods) and controlled food challenges, atopy patch tests or elimination diets may be needed
- Limited food allergy testing may be considered in children <5 years with moderate-severe or refractory disease and/or a history of an allergic reaction after a particular food exposure
- Most children will outgrow food hypersensitivity within the first few years of life
- Patch tests if contact dermatitis is suspected, eg palmar or facial dermatitis
- Identify potential allergens by careful history and selective allergy tests
Evaluation
Criteria for Diagnosis (Based on criteria developed by Hanifin 1991)
Major Features (must have ≥3)
- Pruritus
- Typical morphology and distribution
- Facial and extensor involvement in infants and children
- Flexural lichenification and linearity in adults
- Dermatitis - chronic or chronically relapsing
- Personal or family history of atopy - asthma, allergic rhinitis, atopic dermatitis
Minor/Less Specific Features
- Cheilitis
- Hand/foot dermatitis
- Scalp (cradle cap) dermatitis
- Ichthyosis, hyperlinearity, keratosis pilaris
- IgE reactivity (increased serum IgE, radioallergosorbent, or prick test reactivity)
- Periauricular fissures
- Eczema
- Perifollicular accentuation
- Cutaneous infections (Staphylococcus aureus, Herpes simplex)
- Xerosis
- Recurrent conjunctivitis
- Keratoconus
- Anterior subcapsular cataract
- Ptyriasis alba
- White dermographism
Assessment
Disease Severity
- Severity is assessed using different scoring methods [eg SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Patient Oriented Eczema Measure (POEM), Three Items Severity Score (TISS)]
- SCORAD is the scoring method developed by the European Task Force of Atopic Dermatitis (ETFAD), which uses area/extent affected, intensity and subjective symptoms to score the severity of patient’s atopic dermatitis
- Mild disease: <25
- Moderate disease: 25-50
- Severe disease: >50
- TISS is a simplified scoring system based on 3 symptoms of the disease: Erythema, edema/papulation, and excoriation
- POEM measures severity by depending on the patient’s answers to 7 questions based on symptoms and its frequency
- Other scoring systems based on the impact on the quality of life are also used [eg Children’s Dermatology Life Quality Index (CDLQI), the Dermatitis Family Impact (DFI), the Dermatology Life Quality Index (DLQI), and the Infant’s Dermatology Life Quality Index (IDQOL)]
- Ocular or infectious complications may also be present in severe atopic dermatitis
- May require hospitalization for severe eczema or skin infections