Atopic Dermatitis

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    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.

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Quick GuideEczema (Atopic Dermatitis) Pictures Slideshow: Causes, Symptoms and Treatment

Eczema (Atopic Dermatitis) Pictures Slideshow: Causes, Symptoms and Treatment

How do physicians diagnose atopic dermatitis?

Atopic dermatitis is generally diagnosed based on a physical examination 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.

A skin biopsy (a sample of a small piece of skin that is sent to the lab for examination under the microscope) is rarely helpful to establish the diagnosis. Many patients with severe atopic disease may have elevated numbers of a certain type of white blood cells (eosinophils) and/or and elevated serum IgE level. These tests can support the diagnosis of atopic dermatitis. Additionally, skin swab (long cotton tip applicator or Q-tip) samples may be sent to the lab to exclude staphylococcal infections of the skin which may complicate atopic dermatitis.

Since itching tends to be the dominant 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.

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. Positive skin scratch/prick test results are difficult to interpret in people with atopic dermatitis and are often inaccurate.

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
  • Ichthyosis
  • Hyper linear palms
  • Keratosis pilaris
  • Hand or foot dermatitis
  • Cheilitis (dry or irritated lips)
  • Nipple eczema
  • Susceptibility to skin infection
  • Positive allergy skin tests
Medically Reviewed by a Doctor on 10/9/2015
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