Pathogenesis, clinical manifestations, and diagnosis of atopic dermatitis (eczema)

Atopic dermatitis - Severe atopic dermatitis in a 12-year-old girl showing in the typical location of the popliteal fossae. Note the oozing of serous fluid from the most involved areas, plus the papular component and erythema.
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SUMMARY AND RECOMMENDATIONS

● Atopic dermatitis is a chronic pruritic inflammatory skin disease that occurs most frequently in children, but also affects adults. A family history of atopy (eczema, asthma, or allergic rhinitis) and the loss-of-function mutations in the filaggrin (FLG) gene, involved in the skin barrier function, are major risk factors for atopic dermatitis. (See ‘Introduction’ above and ‘Epidemiology’ above and ‘Risk factors’ above.)

● The cardinal features of atopic dermatitis are dry skin and severe pruritus that is associated with cutaneous hyperreactivity to various environmental stimuli, including exposure to food and inhalant allergens, irritants, and infection. Erythema, papulation, oozing and crusting, excoriation, and lichenification vary with the patient’s age and stage of lesions. (See ‘Clinical manifestations’ above.)

● The diagnosis of atopic dermatitis is clinical, based upon history, morphology, and distribution of skin lesions and associated clinical signs. Diagnostic criteria for the clinical diagnosis include:
• Evidence of pruritic skin (mandatory), plus three or more of the following major criteria
• History of dermatitis involving the skin creases
• Visible dermatitis involving flexural surfaces
• Personal or family history of asthma or hay fever
• Presence of generally dry skin within the past year
• Symptoms beginning in a child before the age of 2 years or, in children <4 years, dermatitis affecting the cheeks or dorsal aspect of extremities

● Skin biopsy and laboratory testing, including immunoglobulin E (IgE) levels, are usually not necessary in patients felt clinically to have atopic dermatitis.

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