What Happens During the Symptom History and Physical Exam?

The diagnosis of atopic dermatitis (AD) begins with a patient’s medical history and a physical exam. During the history, the physician or nurse will ask about a patient’s personal health experiences, as well as family health conditions. During the physical exam, a doctor examines the patient’s body for signs of disease.1

The symptoms of AD will be noted in the physical exam or discussed during the symptom history. Common symptoms of AD include:

History of skin care

The history will frequently include a discussion of the patient’s bathing or showering frequency, the use of soaps or soap-free cleansers, the use of moisturizers or emollients, and previous use of medications, including over-the-counter creams, antihistamines, or antibiotics.4

Symptom specifics

The frequency of symptoms is also important in a diagnosis of AD. Patients will be asked how often they are experiencing symptoms of AD, as well as the severity of the symptoms. For example, the intensity of itch frequently impacts the quality of life for a person with AD. Quality of life may also be assessed with questions about the individual’s sleep, impact of the condition on daily activities, and the persistence of the disease.1 Patients will also be asked about potential triggers and alleviating factors for their AD.

Family history

Medical history for an individual also includes questioning about health conditions that affect close family members. The majority of people with AD (approximately 70%) have someone in their family with the condition or with an associated condition such as seasonal allergies or asthma. An individual’s chances of developing AD are 2- to 3-fold higher in children who have a parent with AD. If both parents have AD, the child’s chances of developing the skin condition increase to 3- to 5-fold.1

Triggers

AD can be triggered by a number of factors, and patients will be asked about factors that trigger their symptoms, such as:

History of allergies

People with AD are at an increased risk of developing asthma and allergies, including food allergies. During the symptom history, the doctor will likely ask about any allergies or asthma. Those patients that have symptoms of allergies or whose AD is persistent or difficult to treat may receive additional testing for allergens. Tests for allergens include skin prick testing and blood tests.7

Emily Downward | June 2017
View References
  1. Eichenfield LF, Tom WL, Chamilin SL, et al. Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology. 2014;70:338-351.
  2. National Eczema Association. Accessed online on 4/11/17 at https://nationaleczema.org/.
  3. MedlinePlus. Accessed online on 4/12/17 at https://medlineplus.gov/ency/article/000853.htm.
  4. DermNet New Zealand. Accessed online on 4/25/17 at http://www.dermnetnz.org/topics/guidelines-for-the-diagnosis-and-assessment-of-eczema/.
  5. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35:161-183.
  6. Tollefson MM, Bruckner AL. Atopic dermatitis: skin-directed management. Am Acad Pediatrics. 2014 Dec;134(6):e1735-1744. doi: 10.1542/peds.2014-2812.
  7. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71(6):1218-1233.