Guidelines on the Management of Atopic Dermatitis ... - Dermatology

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Diagnosis of atopic dermatitis
The diagnosis of this condition is often not straightforward, especially in adults. Several other
conditions have to be considered in the differential diagnosis (vide infra). Where the disease
represents mere continuation of atopic dermatitis from childhood, the diagnosis is usually
easy and the clinical picture also typical. Difficulty arises where onset occurs after the age of
18 years (adult-onset atopic dermatitis) and in these cases the disease pattern is often not
obvious, although it may still present with the usual flexural dermatitis seen in children. Nontypical
morphology and localisation are common with nummular, prurigo-like, follicular and
seborrhoeic patterns often seen 1 . Erythroderma is a rare manifestation of atopic dermatitis in
adults 2 . The physical and environmental factors at play in adults differ from that in children
and this is responsible for the different patterns of involvement.
The traditional criteria set out by Hanifin and Rajka 3 are not used anymore. Williams et al
developed a revised set of criteria 4 and this was validated in the hospital setting 5 and in the
community 6 . It is the opinion of this work group that these criteria should be adopted for the
diagnosis of atopic dermatitis, even though a recent study 7 done on children has shown that
these criteria are not reliable when applied in the low-prevalence rural areas of the Eastern
Cape.