Understanding and Diagnosing Atopic Dermatitis
Reviewed by: HU Medical Review Board | June 2017 | Last updated: December 2020
Atopic dermatitis (AD), also known as atopic eczema is a chronic disease that affects the skin and occurs in people of all ages, with the majority of cases occurring in children. Atopic dermatitis is the most common of the many types of eczema. Eczema is a general term for many types of skin inflammation (dermatitis).
What are the symptoms?
Atopic dermatitis impacts people differently, with itching being one of the most frustrating symptoms. Other common symptoms include red and inflamed skin,weeping or oozing sores, scaling, crusting and cracking of the skin. Atopic dermatitis most often affects infants and young children with 90% of cases occurring before the age of 5.1 Some individuals experience AD into adulthood, and others only experience symptoms of AD later in life.
As a chronic condition, AD may have periods of remission (when symptoms are lessened or non-existent) and periods of relapse (flares of worsened symptoms). AD may appear differently depending on the age of the person affected.2
What are the causes?
While the exact cause of atopic dermatitis is unknown, there are several factors that appear to play a role in the development of atopic dermatitis. Factors include a combination of genetic (hereditary) and environmental factors. In autoimmune conditions like AD, the immune response is abnormally over-activated, causing a chronic inflammatory state that affects the skin.1
What are the triggers?
Atopic dermatitis can be triggered by a number of factors and triggers may be different from one person to the next. It is important for anyone with AD to work with their healthcare provider to identify their personal triggers and avoid or prevent them whenever possible.
Increased risk of other atopic conditions
Atopic dermatitis has been associated with other so-called atopic disorders such as hay fever and asthma. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. About 30% of children with AD develop asthma, and 33% of children with moderate to severe AD have food allergies. AD also puts a person at a higher risk of developing hay fever, or allergic rhinitis.1,3
How is it diagnosed?
To diagnosis atopic dermatitis a health care provider will conduct both a physical examination and symptom history. Diagnosing atopic dermatitis is based on several factors including an examination of how the skin looks and family and personal history. Some people may require additional testing such as a skin biopsy to confirm or rule out that the symptoms are not due to other causes.
Diagnostic guidelines for atopic dermatitis
The American Academy of Dermatology (AAD) has diagnostic guidelines that identify essential features which must be present to classify a skin condition as AD.
The diagnostics guidelines are as follows:
- Pruritus, or itching
- Eczema or inflamed skin that has typical age-specific patterns and a chronic or relapsing history2
The age-specific patterns of atopic dermatitis are as follows:
- In infants and young children: eczema on face, neck, and extensor (outer surfaces of the limbs) surfaces
- In any age, current or previous eczema on flexural (inner surfaces of the joints, like the inner crease of the elbow or knee) surfaces2