- Positive family history of allergic rhinitis, asthma or eczema
- Pruritis is the most common symptom
- Course marked by exacerbations and remissions.Seventy-five per cent of cases of atopic eczema begin before the age of 6 months, and 80–90% before the age of 5 years.
- In infancy, atopic eczema tends to be vesicular and weeping. It often starts on the face with a non-specific distribution elsewhere, commonly sparing the napkin (diaper) area.
- In childhood, the eczema becomes leathery, dry and excoriated, affecting mainly the elbow and knee flexures ,wrists and ankles. A stubborn ‘reverse’ pattern affecting the extensor aspects of the limbs is also recognized.
- In adults, the distribution is as in childhood with a marked tendency towards lichenification and a more widespread but low-grade involvement of the trunk, face and hands. While dermographism is often striking, but not diagnostic of atopic eczema.
- Other cutaneous stigmata of AD are perioral pallor, an extra fold of skin beneath the lower eyelid (Dennie’s line), increased palmar markings, and increased incidence of cutaneous infections, particularly with Staphylococcus aureus.
- Atopic individuals often have dry itchy skin, abnormalities in cutaneous vascular responses, and, in some instances, elevations in serum lgE.
- Biopsy is the best test
- Excoriation, Lichenification, Hyperlinear palms are seen.
Clinical diagnostic criteria for diagnosis of Atopic Dermatitis:
- A chronically itchy skin (or report of scratching or rubbing in a child)
Plus three or more of the following:
- History of itchiness in skin creases such as folds of the elbows, behind the knees, fronts of ankles or around the neck (or the cheeks in children under 4 years)
- History of asthma or hay fever (or history of atopic disease in a first-degree relative in children under 4 years)
- General dry skin in the past year
- Visible flexural eczema (or eczema affecting the cheeks or forehead and outer limbs in children under 4 years)
- Onset in the first 2 years of life (not always diagnostic in children under 4 years)