Clinical Presentation
Signs and Symptoms
Infants <2 Years Old
Atopic Dermatitis Pediatric_Initial Assesment 1
Signs of inflammation usually develop during the third month of life. The patient commonly presents with red, scaling, dry areas usually found on the facial cheeks and/or chin. Lip licking may result in scaling, oozing, and crusting on the lips and perioral skin, eventually leading to secondary infections. Perioral and perinasal sparing can be characteristic, and the patient may present with no lesions in these areas. Continued scratching or washing will create scaling, oozing, red plaques on cheeks. The infant may be restless or agitated during sleep. A small number of infants may present with generalized eruptions such as papules, redness, scaling, and lichenification. The diaper area is usually not affected.
Children 2-12 Years Old
Atopic Dermatitis Pediatric_Initial Assesment 2
Inflammation in the flexural areas (eg neck, wrists, ankles, and antecubital fossae) may be seen. Rash may be contained to one or two areas. This may progress to involve more areas (eg neck, antecubital and popliteal fossae, wrists, and ankles). Papules quickly change to plaques and then lichenify when scratched. Constant scratching may lead to excoriations and eventual areas of hypo- or hyperpigmentation.
Adolescents ≥12 Years Old
Atopic Dermatitis Pediatric_Initial Assesment 3
There is a resurgence of inflammation that recurs near puberty. This is usually seen on the hands and feet. The pattern of inflammation is the same as in a child 2-12 years old. Dry, scaling, erythematous papules and plaques may also be seen.
Tiền sử bệnh
History should be obtained from the patient or parent, focusing on the onset and pattern of the skin lesions, previous or current treatments and their effectiveness, and possible triggers (eg irritants, dry weather, heat, sweating, pets, dust, or skin infections). Investigate exacerbating factors (eg aeroallergens, foods, infections, irritating chemicals, emotional stress) but is not very useful clinically. Ask about suspected food allergies, dietary history, and any food restrictions. In infants and children, assess growth and development. Obtain a personal and family history of atopic diseases.
Khám thực thể
On physical examination, the appearance and distribution of atopic dermatitis lesions vary depending on the disease phase and the patient’s age. Skin findings may also change over time as the condition progresses or improves. Assess the appearance of skin lesions (eg xerosis, vesicles, papules, lichenification, and hyperpigmentation), as well as their location (eg flexural areas [eg antecubital fossae, wrists, and ankles], hands, trunk, and face).
Diagnosis or Diagnostic Criteria
The diagnosis of atopic dermatitis is based on the patient’s history and physical exam.
Hanifin and Rajka Criteria for Diagnosis of Atopic Dermatitis
Major Criteria (must have ≥3)
- Pruritus
- Typical morphology and distribution
- Facial and extensor involvement in infants and children
- Dermatitis (chronic or chronically relapsing)
- Personal or family history of atopy (asthma, allergic rhinitis, atopic dermatitis)
Minor Criteria (must have ≥3)
- Facial features: Facial pallor, facial erythema, hypopigmented patches, infraorbital darkening, infraorbital folds (Dennie-Morgan folds), cheilitis, recurrent conjunctivitis, anterior neck folds
- Facial features: Facial pallor, facial erythema, hypopigmented patches, infraorbital darkening, infraorbital folds (Dennie-Morgan folds), cheilitis, recurrent conjunctivitis, anterior neck folds
- Complications: Susceptibility to cutaneous infections, impaired cell-mediated immunity, immediate skin-test reactivity, elevated IgE, keratoconus, anterior subcapsular cataracts
- Others: Early age of onset, dry skin, ichthyosis, hyperlinear palms, keratosis pilaris, hand and foot dermatitis, nipple eczema, white dermatographism, perifollicular accentuation
United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis
Itchy skin condition plus ≥3 of the following:
- Visible flexural dermatitis with involvement of skin creases or on the cheeks and extensor surfaces for infants <18 months old
- Flexural involvement (eg antecubital and popliteal fossa) or on the cheeks and extensor surfaces for infants <18 months old
- History of dry skin within the last 12 months
- Personal history of asthma or allergic rhinitis or atopic dermatitis in a first-degree relative if <4 years old
- Signs and symptoms started when <2 years of age in patients ≥4 years old