Materiały źródłowe

• #1 Atopic Dermatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html

  Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. […] The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings. […] Atopic dermatitis is a clinical diagnosis with no definitive laboratory test. Approximately 80% of patients with atopic dermatitis are diagnosed and treated in the primary care setting. […] The American Academy of Dermatology (AAD) has streamlined the diagnosis using previously validated diagnostic criteria. […] The AAD criteria differentiate essential features that must be present for diagnosis, such as pruritus; important features that support the diagnosis, such as early age at onset; and associated features that suggest the diagnosis but are nonspecific, such as lichenification. […] The Scoring Atopic Dermatitis index is the most widely used validated clinical tool to classify atopic dermatitis severity based on the affected body area and intensity of lesion characteristics.

• #1 Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7395647/

  Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating, significantly impairing quality of life. […] This article provides an overview of AD, including strategies for differential diagnosis and assessment of disease severity to guide treatment selection. […] Clinical presentation and severity of AD varies widely, and diagnosis is not always straightforward, especially in adults. […] A diagnosis of AD is made on the basis of clinical presentation and history, with exclusion of multiple erythematous and eczematous conditions. Diagnosis is generally straightforward in infants and young children, but can be challenging in severe cases and in adults. […] Over the years, several sets of criteria have been developed to assist with the diagnosis of AD. The Hanifin-Rajka (H-R) criteria are comprehensive and generally considered the gold standard for AD diagnosis.

• #1 Atopic Dermatitis Diagnosis & Evaluation | Clinical Guidance

  https://www.healio.com/clinical-guidance/atopic-dermatitis/diagnosis-and-evaluation-diagnosis

  Atopic Dermatitis (AD) is a heterogeneous disorder with a wide spectrum of clinical signs, symptoms, severity and clinical course. Consequently, there is no single tool that comprehensively assesses all aspects of the disease. There are presently >60 measures that have been used to assess the severity of AD. These assessments vary considerably with respect to content, scale, instructions, validity and concordance. Numerous scales are also used to assess the signs, symptoms and quality of life (QOL) disturbance of AD. This module will review the common diagnosis criteria and clinical outcome assessments used in AD. The properties, strengths and weaknesses of these assessments will be discussed, as well as their utility for assessing AD in controlled trials and clinical practice. […] The diagnosis of AD is made clinically based on patient medical history, morphology and distribution of skin lesions and the presence of associated comorbidities (e.g., food allergies, asthma, allergic rhinitis). Several groups have devised formal sets of criteria to aid in classification of AD; the most notable are discussed below. A systematic review of randomized controlled trials (RCTs) with a pharmacologic intervention from 2007 to 2016 found that the Hanifin and Rajka criteria were most commonly used (41.0%), followed by the UK refinement of the Hanifin and Rajka criteria (9.0%), Japanese Dermatological Association criteria (4.2%), and American Academy of Dermatology (AAD) criteria (3.8%).

• #1 Atopic Dermatitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1049085-overview

  The following features should be considered in the diagnosis of AD in accordance with the American Academy of Dermatology (AAD) 2014 Guidelines: […] Essential features (must be present) are as follows: […] Pruritus […] Eczema (acute, subacute, chronic) – (1) Typical morphology and age-specific patterns (facial/neck/extensor involvement in children, flexural involvement in any age group, sparing of the groin and axillary regions); (2) chronic or relapsing history […] Important features (supporting the diagnosis) are as follows: […] Early age of onset […] Atopy – (1) Personal and/or family history; (2) IgE reactivity […] Xerosis […] Associated features (nonspecific but suggesting the diagnosis) are as follows: […] Atypical vascular responses (eg, facial pallor, delayed blanch response)

• #1 Atopic Dermatitis: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/atopic-dermatitis/diagnosis-treatment-and-steps-to-take

  Diagnosing atopic dermatitis may include the following: […] Examining your skin and the rash. […] Ordering laboratory tests, such as: […] Your doctor may need to see you or your child several times to make an accurate diagnosis and to determine if symptoms are from other diseases and conditions or from atopic dermatitis.

• #1 Atopic Dermatitis: A Review of Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0915/p1191.html

  Atopic dermatitis is a common, potentially debilitating condition that can compromise quality of life. […] The diagnosis of atopic dermatitis is based on the findings of the history and physical examination. Exposure to possible exacerbating factors, such as aeroallergens, irritating chemicals, foods and emotional stress, should be investigated. […] Unfortunately, no specific laboratory findings or histologic features define atopic dermatitis. […] The diagnostic features of atopic dermatitis are listed in Table 1. The diagnosis requires the presence of at least three major features and at least three minor features. […] Pruritus is a universal finding in atopic dermatitis. […] The skin lesions observed in atopic dermatitis vary greatly, depending on the severity of inflammation, different stages of healing, chronic scratching and frequent secondary infections.

• #1 Atopic eczema – NHS

  https://www.nhs.uk/conditions/atopic-eczema/

  Atopic eczema (atopic dermatitis) is a common skin condition that causes itchy skin. […] Atopic eczema can make your skin: itchy, dry, cracked, crusty, scaly or thickened, red, white, purple or grey, or lighter or darker than the skin around it (depending on your skin tone), blister or bleed. […] Symptoms can start at any age, but they usually start in babies and young children and tend to get better as they get older. […] Non-urgent advice: See a GP if: you or your child have symptoms of atopic eczema, treatments are not helping your atopic eczema. […] Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if: You or your child have atopic eczema and: it’s blistered, crusty, leaking fluid or has spots filled with pus, it’s painful, swollen or feels warm, it suddenly gets worse or gets bigger, you have a high temperature or feel generally unwell.

• #1 Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7395647/

  Assessment of disease severity is a guideline-recommended first step in treatment selection and valuable for monitoring treatment response. […] Numerous tools have been developed for severity assessment; these are summarized in Table III. Validated measures include the SCORing AD (SCORAD) index and the Eczema Area and Severity Index (EASI). […] Treatment of AD follows a multifaceted, stepwise approach that is tailored according to disease severity. […] For all patients, basic management and flare prevention consists of daily showers or baths followed immediately by the application of emollients and moisturizers, with avoidance of triggers such as irritants, aero- or food allergens, and extremes of heat, cold, or humidity. […] Crisaborole and dupilumab are the first new classes of anti-inflammatory medications for AD to be FDA approved since TCIs approval nearly 20 years ago. […] Proper diagnosis that excludes conditions with similar skin manifestations, together with assessment of AD severity, is crucial to selecting appropriate treatment and achieving control of the intense itch and rash that can disrupt sleep, contribute to depression and anxiety, and impair QOL.

• #1 Atopic Dermatitis Diagnosis & Evaluation | Clinical Guidance

  https://www.healio.com/clinical-guidance/atopic-dermatitis/diagnosis-and-evaluation-diagnosis

  There is no gold standard for evaluating the severity of AD. Since there are no reliable laboratory tests or biomarkers to assess the severity of AD, clinicians must rely upon clinical assessments of disease parameters that can be subjective and difficult to standardize. […] Given the increasing number of outcome measures developed for AD, the Harmonizing Outcome Measures in Eczema (HOME) international consensus group was assembled to promote the standardization of use of AD outcome measures in clinical trials internationally. […] SCORAD was inaugurated in 1993 by the European Task Force on AD, and is the most commonly used objective assessment in RCTs for AD. […] Objective SCORAD (oSCORAD) includes the assessments for lesional severity and extent, but not symptoms. […] EASI was developed as a modification of the well-established Psoriasis Area and Severity Index (PASI).

• #1 Eczema Diagnosis | National Jewish Health

  https://www.nationaljewish.org/conditions/eczema/do-i-have-eczema

  People who suspect that they (or their children) have atopic dermatitis should carefully examine skin areas, keeping three questions in mind: […] If the answer to any one of these questions is yes, the next step is to consult a medical specialist–allergist/immunologists or dermatologists know a lot about eczema. They can get an in-depth history and perform additional diagnostic tests, if necessary, including: […] A detailed medical history is the most important and reliable tool for diagnosing eczema. An allergist or dermatologist will ask a host of questions, focusing on when the rash appears, where it appears, and how often it does so. […] While the medical history is of paramount importance, additional tests can help support the diagnosis of atopic dermatitis or identify other conditions that may be causing symptoms instead. Some of these tests are:

• #1 Dermatitis (Eczema) Testing and Treatment | Mya Care

  https://myacare.com/procedure/dermatitis-eczema-testing-and-treatment

  Dermatologists i.e. doctors who have specialized in the treatment of skin disorders are the doctors who are involved in diagnosing and treating eczema. […] The dermatologist can make a diagnosis of dermatitis (eczema) by examining the patients skin as well as medical history. […] Following tests are done to diagnose dermatitis (eczema): […] Blood tests are done to measure high levels of eosinophils and IgE antibody. Patients with eczema have high levels of eosinophils and IgE antibody in blood. Measurement of allergen-specific IgE helps to identify specific allergen responsible for eczema. […] Skin biopsy: This test is done to rule out other skin diseases from dermatitis. […] Allergy skin testing: Prick skin tests are done to regular food items or inhalant allergens to indicate any absence or presence of sensitization to specific allergens due to eczema. […] Buccal swabs: By using buccal swabs, cells (DNA) are obtained from inside of the cheek to investigate any mutations in the Filaggrin gene. This gene is one of the causes of eczema.

• #1 Guidelines for the diagnosis and assessment of eczema

  https://dermnetnz.org/topics/guidelines-for-the-diagnosis-and-assessment-of-eczema

  Eczema is a chronic inflammatory skin disease that affects about 20% of children and 3% of adults. It is characterized by pruritus, scratching, and eczematous lesions (dry, scaling and crusted areas of skin), and when chronic may be associated with lichenification (thickening) and pigmentary changes. Eczema is also known as atopic eczema, or atopic dermatitis (eczema). […] The diagnosis of eczema is based on patient history and clinical/physical examination. Features to consider when making a diagnosis are summarized in the following tables. […] The diagnosis of eczema depends on excluding other skin conditions that may show similar features. Other diagnoses should be considered particularly when there is an atypical presentation, associated failure to thrive or inadequate response to treatment.

• #1 Atopic Dermatitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1049085-overview

  Keratosis pilaris/pityriasis alba/hyperlinear palms/ichthyosis […] Ocular/periorbital changes […] Other regional findings (eg, perioral changes/periauricular lesions) […] Perifollicular accentuation/lichenification/prurigo […] Conditions to be excluded are as follows: […] Scabies […] Seborrheic dermatitis […] Contact dermatitis […] Ichthyoses […] Cutaneous T-cell lymphoma […] Psoriasis […] Photosensitivity dermatoses […] Immune deficiency diseases […] Erythroderma of other causes […] Additional diagnostic considerations are as follows: […] No reliable biomarker exists for the diagnosis of AD […] Laboratory testing is seldom necessary, but a complete blood count (CBC) can be useful to exclude immune deficiency; an IgE level can be helpful to confirm an atopic pattern; a swab of skin can be helpful to identify S aureus superinfection […] Allergy and radioallergosorbent testing is of little value […] Biopsy shows an acute, subacute, or chronic spongiotic dermatitis pattern that is nonspecific but can be helpful to rule out other conditions (eg, cutaneous T-cell lymphoma)

• #1 Embracing Clinical Diversity: Diagnosis and Treatment of Atopic Dermatitis Across Shades of Skin – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/features/embracing-clinical-diversity-diagnosis-and-treatment-of-atopic-dermatitis-across-shades-of-skin/

  Clinical phenotypes of atopic dermatitis can vary greatly based on skin color and can make atopic dermatitis difficult to diagnose. […] Recognizing the clinical diversity of presentation among various shades of skin is critical for accurately diagnosing, managing, and treating atopic dermatitis. […] Atopic dermatitis is primarily a clinical diagnosis that can be made by analyzing the patients presentation and history and excluding similar skin conditions. […] Diagnosing atopic dermatitis in infants and children often follows a straightforward process. Diagnosis in adults, however, can pose challenges, particularly if the presentation is severe. […] Atopic dermatitis is primarily a clinical diagnosis and typically does not require diagnostic testing such as a skin biopsy. […] Although atopic dermatitis can present in many different ways, pruritus is a required feature for diagnosis.

• #1 Embracing Clinical Diversity: Diagnosis and Treatment of Atopic Dermatitis Across Shades of Skin – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/features/embracing-clinical-diversity-diagnosis-and-treatment-of-atopic-dermatitis-across-shades-of-skin/

  Both sets of criteria, however, are lacking in the evaluation of assessment of patients of color with atopic dermatitis. […] The HR criteria had demonstrated a poor ability to diagnose atopic dermatitis in non-White races. […] The American Academy of Dermatology (AAD) has developed revised diagnostic criteria using both the HR and UK criteria that are more streamlined and apply to a wider range of ages and skin tones. […] Several other tools exist to aid in the diagnosis of atopic dermatitis, such as the Eczema Area and Severity Index (EASI), the Validated Investigator Global Assessment for Atopic Dermatitis (vIGAAD), and the Six Area, Six Sign Atopic Dermatitis Severity Score (SASSAD).

• #1 Atopic Dermatitis: A Review of Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0915/p1191.html

  Xerosis (dry skin) is another characteristic skin finding in patients with atopic dermatitis. […] In infants and young children with atopic dermatitis, pruritus commonly is present on the scalp, face (cheeks and chin) and extensor surfaces of the extremities. […] Common periocular findings include periorbital hyperpigmentation and Dennie-Morgan folds (prominent folds of skin under the lower eyelid). […] From 50 to 80 percent of patients with atopic dermatitis have or develop asthma or allergic rhinitis. […] Systemic illnesses such as malignancy, thyroid disorders and hepatic or renal failure can also cause pruritus and excoriations. In adults with new-onset pruritus, a thorough history and a complete physical examination are necessary to exclude systemic disease. […] If the history reveals exacerbation of the rash after contact with a particular substance or if standard therapy is unsuccessful, patch testing to identify a cause of allergic contact dermatitis may be indicated.

• #1 Should I See A Dermatologist or Allergist For Eczema? | Asthma and Allergy Foundation of America

  https://community.aafa.org/db/ask-the-allergist/record/should-i-see-a-dermatologist-or-allergist-for-eczema?reply=613688469967709784

  Both allergists and dermatologists can evaluate and treat eczema. There are some things to think about when deciding which specialist to see. […] Allergists can help identify triggers for eczema (e.g., food and environmental allergens). This can be done with a clinical history and allergy testing. They can recommend avoidance measures and environmental controls. In some cases, immunotherapy (allergy shots) can be used. This decreases the body’s immune response to allergens. […] A dermatologist can offer a skin biopsy. This is if the eczema is unusual or is not responding to common treatments. […] Both specialists may recommend skin patch testing. This can rule out allergic contact dermatitis. They can also recommend treatments. To manage difficult cases of eczema, it’s useful to see both specialists.

• #1 Diagnosis of Atopic Dermatitis

  https://www.consultantlive.com/view/diagnosis-of-atopic-dermatitis

  The role of multidisciplinary management in diagnosing atopic dermatitis and when patients typically seek care. […] Pediatricians are often the ones who start off. […] We are the ones on the front line making that initial diagnosis. […] Making that diagnosis right off the bat can help the family, as compared with setting them down a road where they are purchasing things that are not necessary and coming back 3 days, 5 days, or 2 weeks later saying, Things are not better. […] Pediatricians are usually the ones making the initial diagnosis of eczema or atopic dermatitis, but there is a large spectrum of comfort levels in managing the condition among pediatricians. […] They seek care right away. […] Families are desperate to make this better. […] The literature shows this mixed thing where there are high levels of referral, but there is lots of care being given by the primary care community. […] The fortunate aspect is the diagnosis tends to be straightforward. […] Sometimes we have to start from scratch. […] I often think we must go back if they are not responding because sometimes, we are treating the wrong thing.

• #1 Atopic Dermatitis: The Latest on Diagnosis and Assessment | MedPage Today

  https://www.medpagetoday.com/medical-journeys/atopic-dermatitis/103350

  The diagnosis of pediatric and adult atopic dermatitis is based on clinical presentation and history, but with no reliable biomarker to distinguish it from other erythematous and eczematous conditions, such as seborrheic dermatitis, scabies, contact dermatitis, and psoriasis. […] To establish a diagnosis of atopic dermatitis in infants, children, and adults, several essential features must be present. These include pruritus and acute, subacute, or chronic eczema with a chronic or relapsing history, as well as typical morphology and age-specific patterns. […] Conditions that mimic atopic dermatitis must be excluded. […] On occasion, skin biopsy specimens or other tests (such as serum immunoglobulin E, potassium hydroxide preparation, patch testing, and/or genetic testing) may be helpful to rule out other or associated skin conditions.

• #1 How to Test for Atopic Dermatitis

  https://www.verywellhealth.com/how-to-test-for-atopic-dermatitis-11685082

  Atopic dermatitis is primarily diagnosed by a visual examination and collecting your health history. There are no laboratory tests that can confirm an atopic dermatitis diagnosis. However, a healthcare provider may order tests like a patch test or blood test to help rule out other skin conditions. […] Gathering your medical history is an integral part of diagnosing atopic dermatitis. Your healthcare provider will ask: At what age the rash first appeared, if the rash comes and goes, if you have previously had treatment for other skin conditions, and if you have other allergic conditions, such as asthma, hay fever, and food allergies. […] A healthcare provider will carefully examine your skin if they think you could have atopic dermatitis. They are looking for the following most common physical signs of atopic dermatitis: dry skin, eczema rash, which can appear scaly; weeping or leaking fluid; and with a marked change in skin color.

• #1 Atopic Dermatitis: Causes, Symptoms, Diagnosis | National Eczema Association

  https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/

  Atopic dermatitis is typically diagnosed during a doctor visit. This may include a visit with a primary care physician, a dermatologist and/or an allergist. Atopic dermatitis is often diagnosed with a physical examination of the symptoms based on appearance and duration. Other methods of diagnosis include a skin biopsy where a sample of the skin is taken for lab testing to rule out other skin conditions. There are no laboratory tests to confirm a diagnosis of atopic dermatitis. […] For atopic dermatitis daily management, it is important to establish a regular skincare routine that includes bathing and moisturizing to retain moisture and repair the skin barrier. Moisturized skin helps control flares by combating dryness and keeping out irritants and allergens. […] Depending on severity of symptoms and age, atopic dermatitis treatments include lifestyle changes, over-the-counter (OTC) and natural remedies, prescription topical medications, which are applied to the skin; biologics, given by injection; immunosuppressants, usually taken by mouth in the form of a pill; and phototherapy, a form of ultraviolet light treatment. Its important to discuss your treatment options with your doctor to assess what works best for you.

• #2 Atopic dermatitis (Atopic Eczema): Symptoms and Causes — DermNet

  https://dermnetnz.org/topics/atopic-dermatitis

  Atopic dermatitis is usually diagnosed clinically and investigations are not required. Patch testing should be considered, particularly if the dermatitis becomes resistant to treatment. EASI and SCORAD are two scoring systems developed to document the severity of atopic eczema. […] The list of differential diagnoses for atopic dermatitis is long. A short list of common and important diagnoses to consider in children include: Seborrhoeic dermatitis and psoriasis, Genetic disorders with scaly skin, including inherited forms of ichthyosis, primary immunodeficiency diseases, and inherited metabolic disorders, Contact dermatitis. […] Atopic dermatitis affects 15-20% of children and is less common in adults. Sensitive skin persists lifelong. It is impossible to predict whether atopic dermatitis will improve by itself or not in an individual. A meta-analysis including over 110,000 subjects found that 20% of children with atopic dermatitis had persistent disease 8 years later; fewer than 5% had persistent disease 20 years later. Children who developed atopic dermatitis before the age of 2 years had a lower risk of persistent disease than those who developed atopic dermatitis later in childhood or adolescence.

• #2 Atopic Dermatitis: A Review of Current Diagnostic Criteria and a Proposed Update to Management – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/atopic-dermatitis-a-review-of-current-diagnostic-criteria-and-a-proposed-update-to-management-S1545961620P0244X/

  The diagnosis of atopic dermatitis (AD) remains primarily a clinical diagnosis, in which several clinical signs and symptoms including pruritus, the presence and location of skin lesions, and a personal or family history of atopic conditions are used to facilitate a diagnosis. […] Several sets of diagnostic criteria for AD have been described in recent decades; none are used universally, and each varies in the diagnostic features given prominence, thus precluding comparability between epidemiological studies. […] In the absence of a definitive laboratory test, a diagnosis of AD is made based on the presence and distribution pattern of lesions with specific morphologic features, associated clinical findings, and a personal or family history of atopy. […] The most widely used and recognized criteria for the diagnosis of AD are the HanifinRajka criteria, introduced in 1980, which remain one of the primary criteria used in the hospital setting today.

• #2 Atopic Dermatitis Diagnosis & Evaluation | Clinical Guidance

  https://www.healio.com/clinical-guidance/atopic-dermatitis/diagnosis-and-evaluation-diagnosis

  The 1980 Hanifin and Rajka criteria are the original and most commonly employed diagnostic criteria for AD. A diagnosis of AD under the Hanifin and Rajka criteria requires that patients meet three of four major criteria and three of 23 minor criteria. Although comprehensive and used commonly in clinical trials, these criteria may not be practical in clinical practice for several reasons: 1) the large number of criteria are cumbersome, 2) some criteria are nonspecific, such as pityriasis alba; and 3) other criteria are uncommon in AD despite being fairly specific, such as upper lip cheilitis. As such, several groups have proposed modifications to address these limitations. […] The UK Working Party simplified the Hanifin and Rajka criteria, requiring patients to meet a single mandatory condition (i.e., itchy skin condition) plus three of five minor criteria. No laboratory testing is required, making these criteria better suited for epidemiologic and population-based studies, in addition to clinical practice. Both the Hanifin and Rajka criteria and UK criteria have been validated in studies and in a range of populations.

• #2 Atopic Dermatitis: Overview of Current Diagnosis – Atopic Dermatitis

  https://alleviate-ad.com/provider-toolkit/diagnosis/

  No clear consensus has emerged regarding the diagnostic work-up that should be performed when evaluating patients with AD, particularly in adult patients. Diagnostic approaches vary widely. […] The diagnosis of AD remains clinical because there are no known reliable biomarkers that can distinguish AD from other diseases. […] According to the American Academy of Dermatology, patients with presumed AD should have their diagnosis made based on a combination of features. […] „Associated features” help suggest the diagnosis of AD but are nonspecific. […] In addition, other conditions must be excluded, such as scabies, seborrheic dermatitis, contact dermatitis, ichthyosis, cutaneous T-cell lymphoma, psoriasis, photosensitivity dermatoses, immunodeficiency diseases, and erythroderma of other causes.

• #2 Atopic Dermatitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1049085-overview

  Keratosis pilaris/pityriasis alba/hyperlinear palms/ichthyosis […] Ocular/periorbital changes […] Other regional findings (eg, perioral changes/periauricular lesions) […] Perifollicular accentuation/lichenification/prurigo […] Conditions to be excluded are as follows: […] Scabies […] Seborrheic dermatitis […] Contact dermatitis […] Ichthyoses […] Cutaneous T-cell lymphoma […] Psoriasis […] Photosensitivity dermatoses […] Immune deficiency diseases […] Erythroderma of other causes […] Additional diagnostic considerations are as follows: […] No reliable biomarker exists for the diagnosis of AD […] Laboratory testing is seldom necessary, but a complete blood count (CBC) can be useful to exclude immune deficiency; an IgE level can be helpful to confirm an atopic pattern; a swab of skin can be helpful to identify S aureus superinfection […] Allergy and radioallergosorbent testing is of little value […] Biopsy shows an acute, subacute, or chronic spongiotic dermatitis pattern that is nonspecific but can be helpful to rule out other conditions (eg, cutaneous T-cell lymphoma)

• #2 Eczema Diagnosis | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/dermatology/eczema-and-inflammatory-skin-disease-center/diagnosis/

  Doctors use a number of pieces of information to help diagnose a patient with atopic dermatitis. These include but are not limited to the following: […] It is important for doctors to know as much about your childs personal medical history as possible because many cases of atopic dermatitis present as patterns that are similar (or, at least, close to the same) from one patient to the next. […] Because of this fact, physicians can use the age at which a childs rash first appeared to help confirm the diagnosis of atopic dermatitis. […] Children with atopic dermatitis may also have a history of other disorders such as allergies/hay fever and/or asthma that may aid in establishing a diagnosis. […] The rash of atopic dermatitis typically exists as three age-related phases, with each phase having its own location of involvement and appearance. […] A familys medical history is often helpful in establishing a diagnosis of atopic dermatitis.

• #2 Diagnosis of atopic dermatitis: From bedside to laboratory

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014001000027

  Atopic dermatitis (AD) is essentially diagnosed clinically. In babies and young children, the diagnosis is usually straightforward. Dry, very pruritic dermatitis starts on the cheeks, with the neck and trunk often involved, but the nappy area spared. Limb involvement follows later – first extensoral, later classically flexural. This is mostly the picture of AD. In adults, the presentation may vary widely. Classic flexural dermatitis may persist, but erythroderma (whole-body involvement), head and neck dermatitis, isolated hand dermatitis and nummular dermatitis may be more difficult to identify as AD. […] The diagnosis of atopic dermatitis (AD) is often not straightforward, especially in adults. Young babies who present with typically dry pruritic dermatitis in the classic distribution according to the age of the child are easy to diagnose. Several other conditions have to be considered in the differential diagnosis, as discussed below. Where the disease represents a mere continuation of AD since childhood, the diagnosis is usually easy and the clinical picture typical. With onset 18 years of age (adult-onset AD), the disease pattern is often not obvious, although it may still present with the usual flexural dermatitis seen in children. Non-typical morphological features and localisation are common with nummular, prurigo-like, follicular and seborrhoeic patterns that are often seen. In adults, erythroderma is a rare manifestation of AD. The physical and environmental factors for adults differ from those for children and are responsible for the different patterns of involvement.

• #2 Eczema: What It Is, Symptoms, Causes, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/9998-eczema

  A healthcare provider will diagnose eczema after a physical exam, where they can take a close look at your skin. […] Symptoms of eczema can look similar to other conditions. Your provider might offer tests to rule out other conditions and confirm your diagnosis. Tests could include: […] A primary care provider may recommend you visit a dermatologist to diagnose and treat your eczema. A dermatologist specializes in skin conditions. […] Your treatment for eczema is unique to you and what caused your symptoms to flare up. Treatment for eczema could include: […] A healthcare provider will diagnose eczema after a physical exam, where they can take a close look at your skin. Most often, people receive an eczema diagnosis as a child, as its common among children, but a diagnosis can happen at any age when symptoms arise.

• #2 Atopic Dermatitis: A Review of Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0915/p1191.html

  Xerosis (dry skin) is another characteristic skin finding in patients with atopic dermatitis. […] In infants and young children with atopic dermatitis, pruritus commonly is present on the scalp, face (cheeks and chin) and extensor surfaces of the extremities. […] Common periocular findings include periorbital hyperpigmentation and Dennie-Morgan folds (prominent folds of skin under the lower eyelid). […] From 50 to 80 percent of patients with atopic dermatitis have or develop asthma or allergic rhinitis. […] Systemic illnesses such as malignancy, thyroid disorders and hepatic or renal failure can also cause pruritus and excoriations. In adults with new-onset pruritus, a thorough history and a complete physical examination are necessary to exclude systemic disease. […] If the history reveals exacerbation of the rash after contact with a particular substance or if standard therapy is unsuccessful, patch testing to identify a cause of allergic contact dermatitis may be indicated.

• #2 Atopic Dermatitis Diagnosis & Evaluation | Clinical Guidance

  https://www.healio.com/clinical-guidance/atopic-dermatitis/diagnosis-and-evaluation-diagnosis

  There is no gold standard for evaluating the severity of AD. Since there are no reliable laboratory tests or biomarkers to assess the severity of AD, clinicians must rely upon clinical assessments of disease parameters that can be subjective and difficult to standardize. […] Given the increasing number of outcome measures developed for AD, the Harmonizing Outcome Measures in Eczema (HOME) international consensus group was assembled to promote the standardization of use of AD outcome measures in clinical trials internationally. […] SCORAD was inaugurated in 1993 by the European Task Force on AD, and is the most commonly used objective assessment in RCTs for AD. […] Objective SCORAD (oSCORAD) includes the assessments for lesional severity and extent, but not symptoms. […] EASI was developed as a modification of the well-established Psoriasis Area and Severity Index (PASI).

• #2 Atopic Dermatitis Diagnosis & Evaluation | Clinical Guidance

  https://www.healio.com/clinical-guidance/atopic-dermatitis/diagnosis-and-evaluation-diagnosis

  The modified EASI (mEASI) is a variant of EASI that is identical but includes an assessment of itch by the patient. […] Global assessments are quick and simple “snapshots” of disease severity. […] The concordance between instruments that assess signs vs symptoms varies considerably between studies. […] Patient-oriented SCORAD (PO-SCORAD) and self-administered EASI (SA-EASI) were developed as PRO analogs of SCORAD and EASI. […] Ideally, the same outcome domains should be assessed in a patient visit to promote the effective translation of results from clinical trials to general practice.

• #2 Eczema Diagnosis | National Jewish Health

  https://www.nationaljewish.org/conditions/eczema/do-i-have-eczema

  Blood tests: These require a small blood sample, typically drawn through a needle in the arm. […] Skin biopsy: In this procedure a doctor first numbs the skin and then removes one or more small pieces of skin, which is used to rule out other skin diseases from atopic dermatitis, such as a low-grade skin cancer or psoriasis. […] Allergy skin testing: If there is concern for an associated food allergy or environmental allergy, prick skin tests can be done to common foods or inhalant/animal allergens to show sensitization or lack of sensitization to specific allergens. […] Patch testing: In this test, small patches covered with allergenic chemicals are placed on the skin for 48 hours, then removed and the skin reaction is evaluated at 72-96 hours. […] Buccal swabs: The inside of the cheek can be swabbed with a cotton applicator to get cells as a source of DNA material to look for mutations in the Filaggrin gene, one of the causes of eczema.

• #2 Diagnosis of atopic dermatitis: From bedside to laboratory

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014001000027

  To diagnose AD, special investigations are rarely necessary, but may be performed mainly to identify trigger factors that flare up or aggravate the condition so that patients may be advised to avoid these. However, these investigations are useful in the management of AD, mostly in children. A skin biopsy is done occasionally and may be useful in an adult with generalised exfoliative erythroderma in order to differentiate it from other causes of erythroderma. Total serum IgE estimation, ImmunoCAP assays for specific IgE and skin-prick tests may be done to confirm the atopic nature of a patient’s condition. The skin-prick test is the most common procedure used to confirm food and inhaled aeroallergen sensitisation. […] Positive tests indicating sensitisation are not necessarily related to food allergy. The predictive values for a history of a food reaction, positive skin-prick test and positive food-specific IgE in isolation are poor for diagnosing food allergy in AD. The role of sensitisation must be interpreted together with the history, and in uncertain cases a food challenge test should be done to prove definite food allergy or food tolerance. If the diagnosis is not clear or the clinical relevance of a positive food allergy test is not certain, a food challenge test should be performed.

• #2 Diagnosis and Management of Atopic Dermatitis for Primary Care Providers | American Board of Family Medicine

  https://www.jabfm.org/content/33/4/626

  The common differential for AD includes seborrheic dermatitis, irritant contact dermatitis, allergic contact dermatitis, plaque psoriasis, and scabies infestation. […] Patch testing can be helpful to confirm the diagnosis of allergic contact dermatitis. […] The management of AD should involve the liberal use of emollients and an avoidance of common irritants. […] In mild-to-moderate AD, TCS are the first-line medical therapy, followed by calcineurin inhibitors, which have been shown to be noninferior to TCS in controlling AD, without the risk of steroid atrophy. […] Topical PDE-4 inhibitors, such as crisaborole, are a new nonsteroidal anti-inflammatory approved for ages 2 years and older. […] For cases of AD that fail to be controlled with topical therapy, phototherapy should be considered, if available. […] Newer biologics, such as dupilumab, have been approved for moderate-to-severe AD and seem to have favorable efficacy and side-effect profiles according to randomized trials.

• #2 Diagnosis, assessment and management of atopic dermatitis in children with skin of colour

  https://www1.racgp.org.au/ajgp/2023/october/diagnosis-assessment-and-management-of-atopic-derm

  Children with SOC presenting with atopic dermatitis lack the classical textbook presentation of poorly defined pruritic, erythematous patches and plaques affecting the flexor surfaces. […] The diagnosis of atopic dermatitis is clinical. However, differential diagnoses in patients with SOC include psoriasis, lichen planus, lichen nitidus and tinea corporis. […] Erythema is difficult to appreciate in patients with richly pigmented skin. A reliance on erythema might risk underestimation of the severity of atopic dermatitis in this demographic. […] The challenges in assessing erythema applies to traditional severity assessment scores such as the Eczema Area and Severity Index (EASI). […] Atopic dermatitis in children with SOC can vary greatly from traditional textbook descriptions. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis itself, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in patients with SOC.

• #2 AAD issues guidelines for atopic dermatitis diagnosis

  https://www.dermatologytimes.com/view/aad-issues-guidelines-atopic-dermatitis-diagnosis

  The American Academy of Dermatology has issued new guidelines for the diagnosis and assessment of atopic dermatitis. […] Misdiagnosis of atopic dermatitis is a concern, especially for adults, and can contribute to making the disease worse, Dr. Elston said in the statement. These guidelines provide criteria for accurately diagnosing atopic dermatitis that differentiate it from other conditions with similar characteristics. […] The guidelines issued by the AAD include three key recommendations: […] Clinicians should ask patients general questions about itch, impact on daily activities, sleep and persistence of the disease; […] Dermatologists should coordinate with other specialists when providing care for patients with atopic dermatitis who also have associated conditions such as sleeping problems, asthma, food allergies, ADHD and other psychological conditions.

• #2 Eczema Vs. Atopic Dermatitis: Causes, Diagnosis, Treatment | Orlando | UCF Health

  https://ucfhealth.com/our-services/dermatology/eczema-vs-atopic-dermatitis/

  Atopic dermatitis and eczema are often associated with each other and are sometimes used interchangeably when describing skin conditions. […] Knowing which condition you have is essential for determining effective treatments, minimizing risk factors and taking preventative measures to restore healthy skin. […] Atopic dermatitis (AD) is an atopic disease, meaning its caused by an immune system dysfunction that triggers an allergic reaction in the body. An inflammatory skin condition, atopic dermatitis is the most common type of eczema. […] Atopic dermatitis may develop due to genetics, various environmental factors, harsh ingredients in bath products and detergents, sensitivity to sunlight and exposure to common allergens (pet dander, pollen, food allergies). […] Atopic dermatitis and other types of eczema are often diagnosed through a physical examination from an experienced dermatologist.

• #2 Dermatitis (Eczema) Testing and Treatment | Mya Care

  https://myacare.com/procedure/dermatitis-eczema-testing-and-treatment

  Dermatologists i.e. doctors who have specialized in the treatment of skin disorders are the doctors who are involved in diagnosing and treating eczema. […] The dermatologist can make a diagnosis of dermatitis (eczema) by examining the patients skin as well as medical history. […] Following tests are done to diagnose dermatitis (eczema): […] Blood tests are done to measure high levels of eosinophils and IgE antibody. Patients with eczema have high levels of eosinophils and IgE antibody in blood. Measurement of allergen-specific IgE helps to identify specific allergen responsible for eczema. […] Skin biopsy: This test is done to rule out other skin diseases from dermatitis. […] Allergy skin testing: Prick skin tests are done to regular food items or inhalant allergens to indicate any absence or presence of sensitization to specific allergens due to eczema. […] Buccal swabs: By using buccal swabs, cells (DNA) are obtained from inside of the cheek to investigate any mutations in the Filaggrin gene. This gene is one of the causes of eczema.

• #2 Atopic Dermatitis: Causes, Symptoms, Diagnosis | National Eczema Association

  https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/

  Atopic dermatitis is typically diagnosed during a doctor visit. This may include a visit with a primary care physician, a dermatologist and/or an allergist. Atopic dermatitis is often diagnosed with a physical examination of the symptoms based on appearance and duration. Other methods of diagnosis include a skin biopsy where a sample of the skin is taken for lab testing to rule out other skin conditions. There are no laboratory tests to confirm a diagnosis of atopic dermatitis. […] For atopic dermatitis daily management, it is important to establish a regular skincare routine that includes bathing and moisturizing to retain moisture and repair the skin barrier. Moisturized skin helps control flares by combating dryness and keeping out irritants and allergens. […] Depending on severity of symptoms and age, atopic dermatitis treatments include lifestyle changes, over-the-counter (OTC) and natural remedies, prescription topical medications, which are applied to the skin; biologics, given by injection; immunosuppressants, usually taken by mouth in the form of a pill; and phototherapy, a form of ultraviolet light treatment. Its important to discuss your treatment options with your doctor to assess what works best for you.

• #2 Diagnosis and Management of Atopic Dermatitis for Primary Care Providers | American Board of Family Medicine

  https://www.jabfm.org/content/33/4/626

  Objective: To provide primary care providers an up-to-date approach to the diagnosis and management of atopic dermatitis (AD). […] Main Message: AD is a common chronic skin disease characterized by immune dysregulation and skin barrier dysfunction. […] The most commonly used diagnostic criteria for AD include 4 components: (1) pruritus, (2) dermatitis in infant or adult distributions, (3) chronic or relapsing dermatitis, and (4) personal or family history of atopy. […] The presence of 3 major and 3 minor criteria are required for a definitive diagnosis of AD. […] The severity of AD is commonly categorized into mild-to-moderate AD involving limited areas of the body affected, milder intensity of pruritus, and sleep loss; and severe AD involving widespread areas of dry skin, high frequency of pruritus, and a significant impact on quality of life.

• #2 How to Test for Atopic Dermatitis

  https://www.verywellhealth.com/how-to-test-for-atopic-dermatitis-11685082

  Healthcare providers typically do not recommend blood tests to diagnose atopic dermatitis, unless they need to gather more evidence to rule out other potential underlying conditions. […] Atopic dermatitis is primarily diagnosed based on a physical exam and your personal and family health history. Laboratory tests may be ordered to rule out other conditions or to corroborate the atopic dermatitis diagnosis by finding other allergic conditions.

• #2

  https://www.healio.com/clinical-guidance/atopic-dermatitis/clinical-presentation-diagnosis

  Numerous biomarkers have been evaluated for utility in diagnosing and/or treating AD. However, there are currently no biomarkers that accurately reflect the severity of AD or its symptoms, or distinguish AD from other diseases. As such, the diagnosis and severity assessment of AD remains entirely clinical.

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