Diagnosis of Atopic Dermatitis

The diagnosis of atopic dermatitis is clinical; no reliable markers exist for diagnosis or assessing disease severity.

Learn more about IgE Levels in Atopic Dermatitis here.

Signs and Symptoms

The chief symptom of atopic dermatitis is pruritus.
Xerosis is often present.
Scratching leads to excoriated and lichenified lesions.
The typical distribution of lesions varies by age (Figures 1–3).
The appearance of the lesions varies by ethnicity.
- Lightly pigmented skin lesions may appear erythematous or as scaly and/or crusted papules, patches, or thin plaques.
- Erythema is less obvious in the skin of children with more pigmentation. The lesion is more papular and postinflammatory hyper- or hypopigmentation is often present.

Typical Distribution of Lesions

Infants

Infants often have scaly, crusted patches on the cheeks, scalp, trunk, thighs, shins, and outer (extensor) surfaces of the upper and lower extremities (see Figure 1).

Figure 1: Distribution of skin lesions in infants with atopic dermatitis.

Young Children

Toddlers and young children commonly present with lesions on the scalp, flexural joints (antecubital and popliteal fossae), and the back of the neck(see Figure 2). Some children exhibit round, crusted (nummular) lesions.

Figure 2: Distribution of skin lesions in young children with atopic dermatitis.

Adolescents and Adults

The distribution of atopic dermatitis lesions in adolescents is flexural but also may include the feet, hands, neck, and face, especially the periorbital area¹ (see Figure 3).

Figure 3: Distribution of skin lesions in adolescents and adults with atopic dermatitis.

Supporting the Diagnosis

Skin conditions often associated with atopic dermatitis that support the diagnosis include

Morgan folds (atopic pleats): prominent skinfolds located beneath the lower eyelids
Dry skin (xerosis)
Hyperlinear palms and soles
Lichenification: thickened skin with prominent creases
Keratosis pilaris: papules centered about follicles that have a central core of keratin debris and, at times, surrounding erythema; lesions usually located on the upper outer arms, face, and thighs
Pityriasis alba: small, poorly defined areas of hypopigmentation located on the face or elsewhere
Ichthyosis vulgaris: polygonal scales, most commonly involving the lower extremities

Look-alikes

Scabies

Example Image

Scabies may occasionally mimic atopic dermatitis, especially when crusted. One helpful distinguishing feature may be involvement of the palms and soles with burrows, papules, pustules, or vesicles.

Linear burrows present.
Beyond infancy, lesions concentrated in interdigital spaces, in wrist flextures, on penis and scrotum, or on areolae.
Other family members may be affected.

Contact Dermatitis

Psoriasis

Example Image 1
Example Image 2

Erythematous papules and plaques with thick, silvery scale.
Scaling of scalp is common; pitting of nails may be observed.
Pruritus is much less common/less severe than in atopic dermatitis.
Extensor (rather than flexural) surfaces of knees and elbows are common sites of involvement.
In infants, diaper area is often involved.

Tinea Corporis

Seborrheic Dermatitis

Example Image 1
Example Image 2

Erythematous, greasy, scaling patches involving the eyebrows, nasolabial folds, and intertriginous areas (eg, postauricular areas, axillae, and, in infants, the diaper area)
Involvement of scalp common
Most often seen in infants younger than 1 year or after adrenarche; less common in prepubertal children
Pruritus often minimal

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The development of this information was made possible through support from Sanofi and Regeneron.

Last Updated

06/11/2021

Source

American Academy of Pediatrics