Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Atopic dermatitis is generally easily diagnosed based on a physical exam and visual inspection of the skin by a physician or dermatologist. Additionally, the history given by the patient and contributory family history help to support the diagnosis. A physician may ask about any history of similar rashes and other medical problems including hay fever (allergies) and asthma. While currently there may be no single specific laboratory test that says unequivocally "this is atopic dermatitis," a skin biopsy (a sample of a small piece of skin that is sent to the lab for examination under the microscope) may be helpful to establish the diagnosis in harder cases. Additionally, gentle skin swabs (long cotton tip applicator or Q-tip) samples may be sent to the lab to exclude infections of the skin which may mimic atopic dermatitis.
Since itching tends to be the main common symptom of the disease for many patients, it is not possible to say all itching is atopic dermatitis. Itching may be seen in many other medical conditions that have nothing to do with eczema. Each patient experiences a unique combination of symptoms, and the symptoms and
severity of the disease may vary over time. The doctor bases the diagnosis on
the individual's symptoms and may need to see the patient several times to make
an accurate diagnosis. It is important for the doctor to rule out other diseases
and conditions that might cause skin irritation. In some cases, the family
doctor or pediatrician may refer the patient to a dermatologist or allergist
(allergy specialist) for further evaluation.
A valuable diagnostic tool is a thorough medical history, which
provides important clues as to the possible causes of the patient's ailment. The
doctor may ask about all of the following: a family history of
allergic disease, whether the patient also has diseases such as hay fever or
asthma, exposure to irritants, sleep disturbances, any foods that
seem to be related to skin flares, previous treatments for skin-related
symptoms, use of steroids, and the effects of symptoms on schoolwork, career,
or social life. Sometimes, it is necessary to do a biopsy of the skin or
patch testing to determine if the skin's immune system overreacts to
certain chemicals or preservatives in skin creams. A preliminary diagnosis of
atopic dermatitis can be made if the patient has three or more
characteristics from each of two categories: major features and minor features. Some of
these characteristics are listed in the box below.
Skin scratch/prick tests (which involve scratching or pricking the skin with a needle that contains a small amount of
a suspected allergen) and blood tests for airborne allergens
generally are not as useful in diagnosing atopic dermatitis as a medical
history and careful observation of symptoms. However, they may
occasionally help the doctor rule out or confirm a specific allergen that might
be considered important in the diagnosis. Negative results on skin
tests are reliable and may help rule out the possibility that certain
substances are causing skin inflammation in the patient. However, positive
skin scratch/prick test results are difficult to interpret in people with atopic
dermatitis and are often inaccurate. In some cases, where the type of dermatitis is unclear, blood tests to check
the level of eosinophils (a type of white blood cell) or IgE (an antibody
whose levels are often high in atopic dermatitis) are helpful.
Major and minor features of atopic dermatitis
Major features
Itching
Characteristic rash in locations typical of the disease (arm folds and behind knees)
Chronic or repeatedly occurring symptoms
Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features
Early age of onset
Dry, rough skin
High levels of immunoglobulin E (IgE), an antibody, in the blood
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Swimmer's ear (external otitis) is an infection of the skin that covers the outer ear canal. Causes of swimmer's ear include excessive water exposure that leads to trapped bacteria in the ear canal. Symptoms include a feeling of fullness in the ear, itching, and ear pain. Chronic swimmer's ear may be caused by eczema, seborrhea, fungus, chronic irritation, and other conditions. Common treatment includes antibiotic ear drops.
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