From the Guidelines
Atopic dermatitis is diagnosed using a combination of essential criteria, including pruritus with symmetrical and age-specific distribution patterns, eczema, and a chronic or relapsing course, as outlined in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1. The diagnosis of atopic dermatitis is made clinically and is based on historical features, morphology and distribution of skin lesions, and associated clinical signs.
Major Criteria
The major criteria for diagnosing atopic dermatitis include:
- Pruritus with symmetrical and age-specific distribution patterns
- Eczema, with specific characteristics depending on the age of the patient, such as facial and extensor involvement in infants and flexural lichenification in adults and children
- Chronic or relapsing course, with a duration of more than 2 months in infancy and more than 6 months in childhood and adolescence These criteria are based on the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, which provides a concise overview of the epidemiology, clinical characteristics, and diagnosis of atopic dermatitis 1.
Minor Criteria
While the Taiwan guidelines do not specify minor criteria, other studies have identified additional factors that may be associated with atopic dermatitis, such as:
- Xerosis (dry skin)
- Ichthyosis
- Immediate skin test reactivity
- Elevated serum IgE
- Early age of onset
- Tendency toward cutaneous infections
- Hand and foot dermatitis
- Nipple eczema
- Cheilitis
- Recurrent conjunctivitis
- Dennie-Morgan infraorbital fold
- Keratoconus
- Anterior subcapsular cataracts
- Orbital darkening
- Facial pallor or erythema
- Pityriasis alba
- Itch when sweating
- Intolerance to wool and lipid solvents
- Perifollicular accentuation
- Food intolerance
- Course influenced by environmental or emotional factors
- White dermographism However, these minor criteria are not essential for the diagnosis of atopic dermatitis, and the diagnosis is often made based on the characteristic distribution of lesions, intense itching, and chronic relapsing course 1.
Diagnosis
The diagnosis of atopic dermatitis should be differentiated from other red, scaly skin conditions, such as seborrheic dermatitis and allergic contact dermatitis 1. The diagnosis of atopic dermatitis requires the presence of all three essential criteria, regardless of severity, as outlined in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1.
From the Research
Major Criteria for Atopic Dermatitis
- Pruritus 2
- Typical morphology and distribution of skin lesions 2
- Chronic or chronically relapsing course 2
- History of flexural involvement 3
- History of asthma/hay fever 3
- History of generalized dry skin 3
- Onset of rash under the age of 2 years 3
- Visible flexural dermatitis 3
Minor Criteria for Atopic Dermatitis
- Tendency towards cutaneous infection 4
- Environmental factors influencing the course of the disease 4
- High IgE level 4, 2
- Intolerance of wool 4
- Xerosis 4
- Infra-orbital fold 4, 2
- Ichthyosis 4
- Early age of onset 4
- Itch on sweating 4
- Palmar hyperlinearity 4
- Food hypersensitivity 4
- Keratosis pilaris 4
- Pityriasis alba 4
- Facial erythema 4
- Cheilitis 4
- Hand eczema 4
- Foot eczema 4
- Intolerance of lipid solvent 4
- Scalp scaling 4
- Infra-auricular fissure 4
- Lichenoid atopic dermatitis 5
- Juvenile plantar dermatosis 5
- Nummular-type atopic dermatitis 5
- Follicular atopic dermatitis 5
- Alopecia of atopic dermatitis 5
- Eczema coxsackium 5
- Psoriasiform, perineal, and lip licker's dermatitis 5