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ForwardTo improve your knowledge on the diagnosis and differential diagnosis of atopic dermatitis, complete the following:
Select from the guidelines for the diagnosis of atopic dermatitis, download and review.
- Hannifin and Rajka Criteria for Atopic Dermatitis (Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980;92 (Suppl): 44-7
Hanifin and Rajka Criteria for Atopic Dermatits - American Academy of Dermatology Criteria for AD: J Am Acad Dermatol 2014;70:338-51: (Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014;70(2):338-51)
AD-part-1.pdf - Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment selection (Fishbein AB, Silverber JI, Wilson EJ, Ong PY. Update on Atopic Dermatitis: Diagnosis, Severity Assessment and Treatment Selection. J Allerg Clin Immunol Pract. 2020;8(1):91-101)
- Scoring options for atopic dermatitis1-5
- SCORAD -Severity Scoring of Atopic Dermatitis One of the most validated and utilized scoring measure for atopic dermatitis that combines patient reported symptoms including itch and sleep loss as well as objective metrics of severity including the area affected as well as localized intensity of the lesions. (Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23-31. doi:10.1159/000247298) Severity Scoring of Atopic Dermatitis
- EASI-Eczema Area and Severity Index enables providers to score intensity of individual areas as well as body surface area. There are different calculations based on age. (Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012;67(1):99-106. doi:10.1111/j.1398-9995.2011.02719.x) https://pubmed.ncbi.nlm.nih.gov/21951293/
- SCORAD -Severity Scoring of Atopic Dermatitis One of the most validated and utilized scoring measure for atopic dermatitis that combines patient reported symptoms including itch and sleep loss as well as objective metrics of severity including the area affected as well as localized intensity of the lesions. (Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1):23-31. doi:10.1159/000247298)
- Identify 3 subtypes of Atopic dermatitis: 6 (Bożek A, Reich A. Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA. Dermatology. 2017;233(1):16-22. doi:10.1159/000472711) https://pubmed.ncbi.nlm.nih.gov/28494438/
- Early Onset AD- begins in the first 2 years of life
- Late onset starts after puberty
- Senile Onset -an unusual subset of AD that begins after 60 years of age has been identified more recently
Differential Diagnosis of Atopic Dermatitis
| Condition | Onset | Symptoms | Location |
| Seborrheic Dermatitis | 2-10 weeks, adolescence to adulthood | Mild to no pruritus | Eyebrows, nasolabial folds, scalp, inguinal folds |
| Contact Dermatitis | All ages | Pruritus | Depends on trigger |
| Psoriasis | All ages | Mild to moderate pruritus | Scalp, extremities, pitting, thickened nails |
| Scabies | All ages | Pruritus | Infants: palms, soles, feet, genitalia Adolescents and adults: interdigital spaces, wrists, axillae, waist, umbilicus and nipples are common |
| Molluscum dermatitis | Primarily children | Pruritus | Extremities, abdomen |
| Tinea corporis | All ages | Pruritis | Any location |
| Mycosis Fungoides | 55 and older | Pruritus | Any location |
| Hypopigmented mycosis fungoides | Childhood and middle age | Bathing suit area Typically, in darker skin | |
| Polymorphous Light Eruptions | Adolescence to early adults | Pruritus | Worsening in spring of summer |
Citations
- Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology. 1997;195(1):10-19.
- Severity Scoring of Atopic Dermatitis: The SCORAD Index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology/ 1993;186 (1):23-31.
- Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012;67(1):99-106.
- Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The Eczema Area and Severity Index-A Practical Guide. Dermatitis. 2022 May-Jun 01;33(3):187-192.
- Bożek A, Reich A. Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA. Dermatology. 2017;233(1):16-22.