ATOPIC DERMATITIS

DIAGNOSIS

 
THINK ABOUT THIS

The patient pictured below has had an intensely itchy rash affecting her face, wrists, ankles, parts of her trunk, particularly her buttocks, and the flexural areas of her arms and legs since infancy.



 
What do you think is the most likely diagnosis? Why?
 

Atopic Dermatitis is the most likely diagnosis in this case because of the typical clinical features described, namely the intensely itchy nature of the rash, the areas affected by it, and the relapsing course of the condition in this patient. These clinical features can be found under the "Major Criteria" used to diagnose atopic dermatitis (AD). Along with a list of major criteria, there is a lengthy list of "Minor Criteria" as well. You can make a diagnosis of AD when a patient exhibits 3 or more "Major" and 3 or more "Minor" criteria.

Major Criteria

To see more detail on either of the first 2 "Major" criteria, click the appropriate underlined word.

A. PRURITUS (**remember that AD is a disease of ITCH)

B. TYPICAL MORPHOLOGY and DISTRIBUTION:

C. CLINICAL PICTURE OF CHRONIC or RELAPSING DERMATITIS

D. PERSONAL or FAMILY HISTORY of ATOPY

Minor Criteria

To see more detail on any of the underlined "Minor" criteria, click the appropriate underlined word in the list.

1. Xerosis

2. Ichthyosis/keratosis pilaris/palmar hyperlinearity

3. Type 1 skin test reactivity

4. Elevated serum IgE

5. Tendancy to skin infection, (S. aureus, herpes simplex)/impaired cell-mediated immunity

6. Hand/foot dermatitis

7. Nipple eczema

8. Conjunctivitis

9. Dennie-Morgan folds

10. Keratoconus

11. Anterior subcapsular cataracts

12. Orbital darkening (atopic "shiners")

13. Facial pallor/erythema

14. Anterior neck folds

15. Pruritus with perspiration

16. Pityriasis alba

17. Intolerance to wool and lipid solvents

18. Perifollicular accentuation

19. Food intolerance

20. White dermographism/delayed blanch

21. Course influenced by environmental/emotional factors

Remember: Although this is a lengthy list of criteria, diagnosing Atopic Dermatitis is not difficult.


 
THINK ABOUT THIS

With respect to the young patient described above,
what other conditions should you consider?


Differential Diagnosis

The entire eczema dermatitis group of disorders forms the differential diagnosis of AD. These disorders fall into two broad categories:

(Click on on the underlined word to see a description of the terms in the following lists.)

Endogenous

  • Atopic dermatitis

  • Seborrheic dermatitis

  • Nummular eczema

  • Stasis dermatitis

  • Perioral dermatitis

  • Neurodermatitis

Exogenous

  • Contact dermatitis

  • Photo contact dermatitis

  • Infective dermatitis

    STOP!

    Review Questions

    1. List the four Major Criteria for Atopic Dermatitis.

    2. What types of ocular changes can occur in AD?

    3. What are the major differences between seborrheic dermatitis and atopic dermatitis?

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