Atopic dermatitis is common pruritic skin condition primarily occurring in infants and children but which may persist into adulthood. It is a genetic disorder influenced by environmental factors. Accurate diagnosis is important especially for assessing response to therapy and for differentiation from other dermatologic conditions.
Stages:
(1) infantile stage (up to 2 years of age): (a) highly pruritic, scaly, red and crusted patches on both cheeks of the face and on the extensor portions of the extremities, (b) eczematous changes of the scalp, (c) wheal formation
(2) childhood stage (2 - 12 years of age): (a) papules on the flexural areas, (b) thickened plaques showing lichenification and excoriation, (c) in Blacks the presence of follicular papular lesions and changes in pigmentation (hyper or hypo)
(3) adult stage (puberty onward): may have no signs or may have a chronic, relapsing condition. If lesions present, (a) lichenification may occur in the flexural areas, (b) facial involvement may occur, (c) wrists, hands, ankles, fingers, feet and toes may be involved.
Major (basic) criteria - 3 or more of the following:
(1) pruritis
(2) typical morphology and distribution (flexural lichenification or linearity in adults; facial and extensor involvement in infants and children)
(3) chronic or chronically-relapsing dermatitis
(4) personal or family history of atopy (asthma, allergic rhinitis, atopic dermatitis)
Minor criteria - 3 or more of the following (in addition to major criteria):
(1) xerosis (presence of generalized dry skin)
(2) ichthyosis, palmar hyperlinearity or keratosis pilaris
(3) immediate (type 1) skin test reactivity
(4) increased serum IgE levels
(5) early age of onset
(6) tendency toward cutaneous infections (especially Staphylococcus aureus and Herpes simplex) or impaired cell-mediated immunity
(7) tendency toward nonspecific hand or foot dermatitis
(8) nipple eczema
(9) cheilitis
(10) recurrent conjunctivitis
(11) Dennie-Morgan infra-orbital fold
(12) keratoconus
(13) anterior subcapsular cataracts
(14) orbital darkening
(15) facial pallor or facial erythema
(16) pityriasis alba
(17) anterior neck folds
(18) itch when sweating
(19) intolerance to wool and lipid solvents
(20) perifollicular accentuation
(21) food intolerance
(22) course influenced by environmental or emotional factors
(23) white dermographism or delayed blanch
