Atopic dermatitis diagnostic study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
Due to the variable [[morphology]], distribution of skin [[lesions]], and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis. Atopic dermatitis is primarily diagnosed based on the [[clinical]] presentation. Currently, the most used [[Criterion|criteria]] worldwide is published by the United Kingdom | Due to the variable [[morphology]], distribution of skin [[lesions]], and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis. Atopic dermatitis is primarily diagnosed based on the [[clinical]] presentation. Currently, the most commonly used [[Criterion|criteria]] worldwide is published by the United Kingdom Working Group and is based on history, morphology, and distribution of [[Eczema|eczematous]] [[lesions]], and clinical features of atopic dermatitis. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
*There is no single diagnostic study of choice for | *There is no single diagnostic study of choice for routine diagnosis of atopic dermatitis, but in selected patients, to rule out other skin conditions, histologic examination of a [[skin biopsy]] and other laboratory tests (eg, [[Immunoglobulin E|serum immunoglobulin E]], [[KOH test|potassium hydroxide preparation]], patch testing, [[genetic testing]]) may be considered.<ref name="pmid242904312">{{cite journal |vauthors=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 |title=Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=70 |issue=2 |pages=338–51 |date=February 2014 |pmid=24290431 |pmc=4410183 |doi=10.1016/j.jaad.2013.10.010 |url=}}</ref> | ||
===Diagnostic Criteria:=== | ===Diagnostic Criteria:=== | ||
*Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest and most accepted [[diagnostic criteria]] being the 1980 Hanifin and Rajka criteria was used | *Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest and most accepted [[diagnostic criteria]] being the 1980 Hanifin and Rajka criteria that was previously used.<ref name="pmid16086748">{{cite journal |vauthors=Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE |title=A comparison between criteria for diagnosing atopic eczema in infants |journal=Br. J. Dermatol. |volume=153 |issue=2 |pages=352–8 |date=August 2005 |pmid=16086748 |doi=10.1111/j.1365-2133.2005.06491.x |url=}}</ref><ref>{{cite journal |last1= Hanifin |first1=Jon M. |last2= Rajka |first2=Georg |date= |title=Diagnostic Features of Atopic Dermatitis|url=https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555924447 |journal= Acta Derm Venereol Suppl (Stockh) |volume=60 |issue=92 |pages=44-47 |doi=10.2340/00015555924447 |access-date= }}</ref> | ||
*Currently, the most used criteria worldwide is published by United Kingdom | *Currently, the most commonly used criteria worldwide is published by United Kingdom Working Group and is based on history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.<ref name="pmid24290431">{{cite journal |vauthors=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 |title=Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=70 |issue=2 |pages=338–51 |date=February 2014 |pmid=24290431 |pmc=4410183 |doi=10.1016/j.jaad.2013.10.010 |url=}}</ref> | ||
*United Kingdom | *The United Kingdom Working Group's criteria includes one mandatory criteria and 3 or more from the 5 major criteria.<ref name="pmid7918017">{{cite journal |vauthors=Williams HC, Burney PG, Pembroke AC, Hay RJ |title=The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation |journal=Br. J. Dermatol. |volume=131 |issue=3 |pages=406–16 |date=September 1994 |pmid=7918017 |doi= |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
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*The basis for making decisions about treatment depends | *The basis for making decisions about treatment depends on:<ref name="pmid10730763">{{cite journal |vauthors=Emerson RM, Charman CR, Williams HC |title=The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading |journal=Br. J. Dermatol. |volume=142 |issue=2 |pages=288–97 |date=February 2000 |pmid=10730763 |doi= |url=}}</ref> | ||
**Presence or absence of [[Sleep disturbances|sleep disturbance]] | **Presence or absence of [[Sleep disturbances|sleep disturbance]] | ||
**Number and location of involved sites | **Number and location of involved sites | ||
| Line 44: | Line 44: | ||
Clinical features and description<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref> | Clinical features and description<ref name="StänderRopper2021">{{cite journal|last1=Ständer|first1=Sonja|last2=Ropper|first2=Allan H.|title=Atopic Dermatitis|journal=New England Journal of Medicine|volume=384|issue=12|year=2021|pages=1136–1143|issn=0028-4793|doi=10.1056/NEJMra2023911}}</ref> | ||
*Essential Features and | *Essential Features and Description | ||
**Eczema - | **Eczema - May be chronic or relapsing with characteristic, age-specific patterns and morphologic features. | ||
***Stages - Acute, subacute, or chronic | ***Stages - Acute, subacute, or chronic | ||
***Severity - Mild, moderate, or severe | ***Severity - Mild, moderate, or severe | ||
***Immunoendo cell type - Th2 cells are seen in | ***Immunoendo cell type - Th2 cells are seen in white and black people, Th2 and Th17 cells are seen in Asians | ||
**[[Pruritus]] | **[[Pruritus]] | ||
*Important features and description | *Important features and description | ||
**Age at onset | **Age at onset typically early, between 2 and 6 months of age | ||
**Personal and/or family history of atopy, secondary to IgE reactivity seen in up to 80% of [[patients]]. | **Personal and/or family history of atopy, secondary to IgE reactivity seen in up to 80% of [[patients]]. | ||
**[[Xerosis]] | **[[Xerosis]] | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
Latest revision as of 19:01, 8 June 2021
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Atopic dermatitis Microchapters |
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Atopic dermatitis diagnostic study of choice On the Web |
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Risk calculators and risk factors forAtopic dermatitis diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shalinder Singh, M.B.B.S.[2], Ogechukwu Hannah Nnabude, MD
Overview
Due to the variable morphology, distribution of skin lesions, and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis. Atopic dermatitis is primarily diagnosed based on the clinical presentation. Currently, the most commonly used criteria worldwide is published by the United Kingdom Working Group and is based on history, morphology, and distribution of eczematous lesions, and clinical features of atopic dermatitis.
Diagnostic Study of Choice
- There is no single diagnostic study of choice for routine diagnosis of atopic dermatitis, but in selected patients, to rule out other skin conditions, histologic examination of a skin biopsy and other laboratory tests (eg, serum immunoglobulin E, potassium hydroxide preparation, patch testing, genetic testing) may be considered.[1]
Diagnostic Criteria:
- Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest and most accepted diagnostic criteria being the 1980 Hanifin and Rajka criteria that was previously used.[2][3]
- Currently, the most commonly used criteria worldwide is published by United Kingdom Working Group and is based on history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.[4]
- The United Kingdom Working Group's criteria includes one mandatory criteria and 3 or more from the 5 major criteria.[5]
| Atopic dermatitis diagnostic criteria | ||
|---|---|---|
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| Adapted from U.K. Working Party's Diagnostic Criteria | ||
- The basis for making decisions about treatment depends on:[6]
- Presence or absence of sleep disturbance
- Number and location of involved sites
- Clinical course of the disease
| The American Academy of Dermatology Diagnostic Criteria for Atopic Dermatitis | ||
|---|---|---|
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Clinical features and description[7]
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References
- ↑ 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 (February 2014). "Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis". J. Am. Acad. Dermatol. 70 (2): 338–51. doi:10.1016/j.jaad.2013.10.010. PMC 4410183. PMID 24290431.
- ↑ Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE (August 2005). "A comparison between criteria for diagnosing atopic eczema in infants". Br. J. Dermatol. 153 (2): 352–8. doi:10.1111/j.1365-2133.2005.06491.x. PMID 16086748.
- ↑ Hanifin, Jon M.; Rajka, Georg. "Diagnostic Features of Atopic Dermatitis". Acta Derm Venereol Suppl (Stockh). 60 (92): 44–47. doi:10.2340/00015555924447.
- ↑ 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 (February 2014). "Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis". J. Am. Acad. Dermatol. 70 (2): 338–51. doi:10.1016/j.jaad.2013.10.010. PMC 4410183. PMID 24290431.
- ↑ 5.0 5.1 5.2 Williams HC, Burney PG, Pembroke AC, Hay RJ (September 1994). "The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation". Br. J. Dermatol. 131 (3): 406–16. PMID 7918017.
- ↑ Emerson RM, Charman CR, Williams HC (February 2000). "The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading". Br. J. Dermatol. 142 (2): 288–97. PMID 10730763.
- ↑ Ständer, Sonja; Ropper, Allan H. (2021). "Atopic Dermatitis". New England Journal of Medicine. 384 (12): 1136–1143. doi:10.1056/NEJMra2023911. ISSN 0028-4793.