Welcome to AD Uncovered, where you can explore the latest in diagnosis, management, and patient support for your patients with AD.
Diagnosing AD
Diagnosis
Although presentation varies, AD is typically characterized by highly pruritic, eczematous, erythematous patches, papules and plaques with excoriations, crusts, and lichenification, most commonly on the flexural areas and the face.1
The main diagnostic criteria for atopic dermatitis (AD) were outlined by Hanifin and Rajka as early as 1980 and modified by Williams et al. in 1994 and 2005.2-4
UK Working Party Diagnostic Criteria
For a diagnosis of AD a patient must have:2,3
– Pruritus
Plus three or more of the following:3
history of flexural involvement
a history of asthma/hay fever
a history of a generalized dry skin
onset of rash under the age of 2 years
visible flexural dermatitis
While the diagnostic criteria have been updated somewhat over the years, these remain the key diagnostic signs for identifying AD.5
Clinical presentation
The primary characteristic of AD is pruritus, which causes significant discomfort to patients, and which can lead to the aggravation of other symptoms through the damage caused to the skin barrier by scratching.6
Other clinical signs of AD can include:6,7
areas of dry skin (xerosis)
especially on the legs
ichthyosis vulgaris or “fish-like” scales on the lower legs and shins
scaling and redness around hair follicles
a goose-bump appearance of hair follicles
exaggerated palmar and plantar creases
periorbital darkening
(discoloration and swelling of the undereye area caused by edema and rubbing)
Barrier dysfunction can make the skin susceptible to bacterial and viral infections as secondary complications.
In particular, staphylococcus colonization and infection often presenting with crusting of the involved skin.6
The appearance of skin lesions in AD differs in form between the acute and chronic stages (see Complex Pathology of AD) and in the typical distribution on the body depending on age.5-7
In the infantile phase of AD lesions may remain localized to the face or extend to the trunk, particularly on the extensor aspects of the extremities.5,6 In the childhood and adult phases, in contrast, lesions are more commonly localized in the flexural areas.5,6 In adulthood other predominant areas of involvement include the neck, upper arms and hands.6
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REFERENCES
- Kim D & Lockey R. Dermatology for the Allergist. World Allergy Org J. 2010;3:202–215.
- Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92(Suppl.):44–7.
- Williams HC, et al. The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131:383–96.
- Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med. 2005;352:2314–24.
- Wollenberg A, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. JEADV 2020;34:2717–2744.
- Maliyar M, et al. Diagnosis and Management of Atopic Dermatitis: A Review. Advances in Skin & Wound Care. 2018;31(12):538–550.
- Eichenfield LF, et al. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. 2003;49(6):1088–95.