Diagnostic / clinical features

(must be present/enough for diagnosis):

A- Pruritus: (worse in evening, create / worsen rash)

B- Typical morphology:

  • Acute: edema, erythematous papules / plaques, vesicles, oozing, crust
  • Subacute: erythema, scaling, variable crust
  • Chronic: thick plaques with lichenification, scale

(all stages can have excoriations & post-inflammatory hyper / hypo-pigmentation)

C- Age-specific distribution:

< 2yo: cheeks (central face-sparing), scalp, extensor extremities, diaper area-sparing

2-12yo: flexural (antecubital, popliteal), wrists, hands, neck, eyelids, groin- and axillae-sparing

Adult/adolescent:

Same as childhood, frequent chronic hand dermatitis

> 60yo: ++ xerosis, no flexural lichenification

D- Chronic / relapsing

(most cases / support diagnosis)

A- Early onset (infancy / early childhood)

B- Personal +/- family history atopy

(IgE reactivity)

C- Xerosis

(less specific)

A- Other filaggrin deficiency conditions (keratosis pilaris, ichthyosis vulgaris)

B- Follicular prominence, lichenification, prurigo

C- Ocular Symptoms 

(recurrent conjunctitivitis, anterior subcapsular cataract, Dennie-Morgan fold, orbital darkening)

D- Regional findings (cheilitis sicca → lip-licker’s eczema; ear eczema; eyelid eczema; head & neck dermatitis→ after puberty, Malassezia aggravating; juvenile plantar dermatosis; hand AD & dyshidrotic eczema; prurigo form; nummular lesions; frictional lichenoid eruption → children, elbows/knees; nipple eczema)

E- Atypical vascular responses (white dermographism, delayed blanching, midfacial pallor)

  • Xerosis
  • Pityriasis alba (hypopigmented macules on face/cheeks → low-grade eczematous inflammation due to abnormal melanosome transfer from melanocytes to keratinocytes)
  • Ichthyosis vulgaris (15% AD, due to FLG gene mutations)
  • Keratosis pilaris (40% AD)
  • Palmar/plantar hyperlineraity (associated with FLG mutations
  • Dennie-Morgan lines
  • Periorbital darkening
  • Anterior neck folds
  • Hertoghe sign (absent/thinned lateral eyebrows)
  • White dermographism (strike skin → white line due to ++ vasoconstriction)
  • Follicular prominence