Diagnosing Atopic Dermatitis: Your Top Five Questions Answered

Atopic dermatitis, also known as eczema, is an itchy, often long-lasting skin condition that can affect patients of all ages. The cause of the disease is unknown though genetic and environmental predisposing factors exist. Multiple loci have been associated with atopic dermatitis. A family history of atopic dermatitis is common.

Before making a diagnosis, it is vital to examine all the factors. We’re answering the top five most common questions concerning atopic dermatitis:

Who Is Most Likely To Present With Atopic Dermatitis?

Majority of cases of atopic dermatitis present in children, with the highest prevalence in early infancy and childhood:

• 5%-20% of children are affected worldwide
• 85% of cases occur in the first year of life
• 95% of cases occur before age 5
• Most cases improve with age
• 1%-3% of cases occur in adults (ie, persist into or arise in adulthood)

The overall incidence of atopic dermatitis is believed to have increased. In the United States, the incidence is higher in urban areas. An increasing trend has also been found in Africa, eastern Asia, western Europe, and northern Europe. Finally, there is a slight predilection toward females.

What Are The Risk Factors For Atopic Dermatitis?

Factors that increase likelihood of atopic dermatitis include:

• Emotional stress
• Inappropriate bathing habits (eg, prolonged, hot showers)
• Underlying infection
• Hot environment/climate
• Environmental allergies

Associated allergic diagnoses/comorbidities:

• Allergic rhinitis
• Asthma
• Ocular
• Newer emerging comorbidities

A family history of atopy (eczema, asthma, or allergic rhinitis) and mutations in the filaggrin (FLG) gene are strong associated risk factors for atopic dermatitis as well.

What Does Atopic Dermatitis Look Like?

When diagnosing atopic dermatitis, look for scaly, erythematous papules and plaques involving the flexural surfaces, particularly the antecubital fossae and popliteal fossae, face, neck, and extremities in general. In chronic cases, lichenification, scaling, and dyspigmentation may be seen.

Scratching leads to lichenification (skin thickening), and due to impaired skin barrier function, increased transepidermal water loss and secondary bacterial infections may also be present.

Body location can vary depending on age. Infants are more likely to present on their face, scalp torso, and extensor aspect of their arms and legs. Toddlers and older children can be more generalized, however, chiefly Atopic dermatitis will present on the flexures of elbows and knees, also wrists and ankles. Adolescents and adults frequently tend to have localized lesions to their face and neck, about 30% also develop hand eczema. Finally, with darker skin types follicular patterns are more common.

What Features and Symptoms Are Important To Support Atopic Dermatitis Diagnosis?

A careful history, to include an appropriate temporal course and family history of atopy, coupled with the appropriate clinical appearance, are keys to diagnosis. Additional features that may suggest atopic dermatitis include:

• Early age of onset
• IgE reactivity
• –Xerosis

How Do You Treat Atopic Dermatitis?

Counsel patients on avoiding known triggers and exacerbating factors such as inappropriate bathing habits, irritants, sweating, hot climates, environmental allergens, and infection prevention. Depending on the climate, moisturizing with appropriate skin care products along with short lukewarm warms may be advised.

Patients should avoid fragrances and dye in these products. An emollient applied directly onto still damp skin post-bath may help seal moisture into the skin. Application of topical anti-inflammatory medications may help as well.

Management involves treatment of coexisting allergic, ophthalmic and/or psychiatric disorders. Patients with co-existent psychiatric conditions may benefit from psychological counseling. Although there is no known cure for atopic dermatitis, the condition may be managed, and quality of life can be improved.

Atopic dermatitis among many skin conditions can be difficult to diagnose. Arm yourself with specialist level information at your fingertips with VisualDx.

Sources

1. VisualDx. Atopic dermatitis. https://www.visualdx.com/visualdx/diagnosis/atopic+dermatitis?moduleId=101&diagnosisId=51378. Last reviewed March 31, 2017. Last updated October 5, 2018. Accessed April 26, 2019.
2. VisualDx. Atopic Dermatitis: VisualDx Clinical Education Series.  https://www.youtube.com/watch?v=gTQkNNnNqvc&list=PLFsXigkdpcr4BHPHzlm85OnNFRMutV-fa&index=3&t=0s. Published August 29, 2018. Accessed April 26, 2019.