Management Of Atopic Dermatitis: Diagnosis And Assessment Of Atopic Dermatitis

Publication Date: December 2, 2013



Patients with presumed atopic dermatitis should have their diagnosis based on the criteria summarized in Box 1. On occasion, skin biopsy specimens or other tests (such as serum immunoglobulin E, potassium hydroxide preparation, patch testing, and/or genetic testing) may be helpful to rule out other or associated skin conditions. (C)
Box 1. Features to be considered in the diagnosis of patients with atopic dermatitis
d Pruritus
d Eczema (acute, subacute, chronic)
  1. Typical morphology and age-specific patterns*
  2. Chronic or relapsing history
*Patterns include:
  1. Facial, neck, and extensor involvement in infants and children
  2. Current or previous flexural lesions in any age group
  3. Sparing of the groin and axillary regions
IMPORTANT FEATURES—Seen in most cases, adding support to the diagnosis:
d Early age of onset
d Atopy
  1. Personal and/or family history
  2. Immunoglobulin E reactivity
d Xerosis
ASSOCIATED FEATURES—These clinical associations help to suggest the diagnosis of atopic dermatitis but are too nonspecific to be used for defining or detecting atopic dermatitis for research and epidemiologic studies:
d Atypical vascular responses (eg, facial pallor, white dermographism, delayed blanch response)
d Keratosis pilaris/pityriasis alba/hyperlinear palms/ichthyosis
d Ocular/periorbital changes
d Other regional findings (eg, perioral changes/periauricular lesions)
d Perifollicular accentuation/lichenification/prurigo lesions
EXCLUSIONARY CONDITIONS—It should be noted that a diagnosis of atopic dermatitis depends on excluding conditions, such as:
d Scabies
d Seborrheic dermatitis
d Contact dermatitis (irritant or allergic)
d Ichthyoses
d Cutaneous T-cell lymphoma
d Psoriasis
d Photosensitivity dermatoses
d Immune deficiency diseases
d Erythroderma of other causes
For patients with presumed atopic dermatitis, there are no specific biomarkers that can be recommended for diagnosis and/or assessment of disease severity. (B)

Monitoring of immunoglobulin E levels is not recommended for the routine assessment of disease severity.

For the general management of patients with atopic dermatitis, available disease severity measurement scales are not recommended for routine clinical practice, because they were not usually designed for this purpose. (C)
For the general management of patients with atopic dermatitis, available patient quality of life measurement scales are not recommended for routine clinical practice. (C)
It is recommended that clinicians ask general questions about itch, sleep, impact on daily activity, and persistence of disease, and currently available scales be used mainly when practical. (C)
Physicians should be aware of and assess for conditions associated with atopic dermatitis, such as rhinitis/ rhinoconjunctivitis, asthma, food allergy, sleep disturbance, depression, and other neuropsychiatric conditions, and it is recommended that physicians discuss them with the patient as part of the treatment/ management plan, when appropriate. (C)
An integrated, multidisciplinary approach to care may be valuable and is suggested for atopic dermatitis patients who present with common associations. (C)

Recommendation Grading




Management Of Atopic Dermatitis: Diagnosis And Assessment Of Atopic Dermatitis

Authoring Organization

Publication Month/Year

December 2, 2013

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings


Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis

Diseases/Conditions (MeSH)

D003876 - Dermatitis, Atopic


eczema, atopic dermatitis


Number of Source Documents
Literature Search Start Date
November 1, 2003
Literature Search End Date
November 1, 2012