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

These criteria are set out as follows in Table 2:
The diagnosis of atopic dermatitis is primarily clinical; special investigations only
contribute in identifying external aggravating factors.
Revised criteria for the diagnosis of atopic dermatitis 4 :
a. Must have:
Pruritus / Itching
b. Plus three or more of the following:
History of flexural dermatitis (front of elbows, back of knees, front of ankles,
neck, around the eyes) or involvement of cheeks and/or extensor surfaces in
children aged up to 18 months
Visible flexural dermatitis involving the skin creases (or involvement of cheeks
and/or extensor surfaces in children aged up to 18 months)
History of a generally dry skin in the past year
Personal history of asthma or hay fever (or history of atopic disease in a first
degree relative in children aged under four years)
Onset under the age of two years (used only for children aged four years or
older at time of diagnosis)
The histological findings on skin biopsy can be suggestive of the diagnosis, but on the whole
it is not helpful and cannot be relied upon to make the diagnosis. 4
Total IgE-levels are significantly raised in about 80% of cases, being normal in the rest,
therefore reducing the value thereof in the diagnosis. The level of IgE does not correlate with
severity of the dermatitis and 15% of non-atopic individuals have raised IgE levels.
Several conditions have to be considered in the differential diagnosis of AD, as listed below.
These have to be excluded on clinical grounds and by employing appropriate investigations.
Table 3: Differential diagnosis of atopic dermatitis in adults:
Seborrhoeic dermatitis
Discoid (nummular) dermatitis
Irritant contact dermatitis (especially of the hands)
Allergic contact dermatitis and airborne contact dermatitis
Photo-allergic and photo-irritant dermatitis
“HIV-dermatitis”
Drug-induced dermatitis
Cutaneous T-cell lymphoma
Psoriasis, especially the erythrodermic type
Scabies
Insect bites
Filariasis