Atopic dermatitis diagnostic study of choice: Difference between revisions
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{{Atopic dermatitis}} | {{Atopic dermatitis}} | ||
{{CMG}}; {{AE}}{{S.S}} | {{CMG}}; {{AE}}{{S.S}}, [[Ogechukwu Hannah Nnabude, MD]] | ||
== 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 criteria worldwide is published by 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:=== | |||
*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 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> | |||
*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" | ||
| | ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Atopic dermatitis diagnostic criteria | ||
|- | |- | ||
| | | | ||
* Mandatory criteria:<ref name="pmid7918017" /> | *Mandatory criteria:<ref name="pmid7918017" /> | ||
** Evidence of pruritus or report of scratching or rubbing by the parent | **Evidence of [[pruritus]] or report of scratching or rubbing by the parent | ||
* 3 or more of the major criteria:<ref name="pmid7918017" /> | *3 or more of the major criteria:<ref name="pmid7918017" /> | ||
** History of skin creases involvement including areas around neck and eyes, front of ankles, front of elbows and back of knees. | **History of skin creases involvement including areas around neck and eyes, front of ankles, front of elbows, and back of knees. | ||
** History of asthma or hay fever( if children <4 years of age - history of atopic disease in a first-degree relative) | **History of [[asthma]] or [[hay fever]] (if children <4 years of age - history of atopic disease in a first-degree relative) | ||
** History of presence of generally dry skin in the past year. | **History of the presence of generally [[dry skin]] in the past year. | ||
** The onset of symptoms in child <2 years of age. This criterion is not recommended if child <4 years old. | **The onset of symptoms in child <2 years of age. This criterion is not recommended if a child <4 years old. | ||
** Visible dermatitis including flexor surfaces. In children <4 years of age, the criterion can involve dermatitis affecting the cheeks or forehead and outer aspects of the extremities. | **Visible [[dermatitis]] including flexor surfaces. In children <4 years of age, the criterion can involve dermatitis affecting the cheeks or forehead and outer aspects of the extremities. | ||
|- | |||
|Adapted from ''U.K. Working Party's Diagnostic Criteria'' | |||
|} | |||
*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]] | |||
**Number and location of involved sites | |||
**Clinical course of the disease | |||
{| class="wikitable" | |||
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |The American Academy of Dermatology Diagnostic Criteria for Atopic Dermatitis | |||
|- | |- | ||
| | | | ||
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 Description | |||
**Eczema - May be chronic or relapsing with characteristic, age-specific patterns and morphologic features. | |||
***Stages - Acute, subacute, or chronic | |||
***Severity - Mild, moderate, or severe | |||
***Immunoendo cell type - Th2 cells are seen in white and black people, Th2 and Th17 cells are seen in Asians | |||
**[[Pruritus]] | |||
*Important features and description | |||
**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]]. | |||
**[[Xerosis]] | |||
*Associated features and description | |||
**Atypical vascular responses - white dermographism or facial pallor. | |||
**Perifollicular lesions - Keratosis pilaris and perifollicular accentuation. | |||
**[[Ocular]] or periorbital lesions -Hertoghe’s sign | |||
**Regional findings - ichthyosis, Perioral changes, pityriasis alba, periauricular lesions, hyper linear palms. | |||
**Lesions related to chronic scratching - prurigo lesions and lesions Lichenification. | |||
*Associated [[conditions]] | |||
**[[Impetigo]] | |||
**[[Skin abscesses]] | |||
**[[Eczema herpeticum]] | |||
**[[Molluscum contagiosum]] infection | |||
**[[Dermatophytosis]] | |||
**[[Candidiasis]] | |||
**[[Asthma]] | |||
**[[Rhinitis]] | |||
**Rhinoconjunctivitis | |||
**[[Food allergy]] | |||
**[[Inflammatory bowel disease]] | |||
**[[Rheumatoid arthritis]] | |||
**[[Cardiovascular disease]] | |||
**[[Sleep disturbance]] | |||
**[[Anxiety]] | |||
**[[Depression]] | |||
**Suicidality | |||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Dermatology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 19:01, 8 June 2021
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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 | ||
|---|---|---|
| ||
| 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 | ||
|---|---|---|
|
Clinical features and description[7]
| ||
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.