The diagnosis of Atopic dermatitis

Atopic dermatitis cannot be diagnosed with a test, like diabetes for example. Atopic dermatitis can only be diagnosed clinically. That means that in order for you to be diagnosed with Atopic dermatitis your doctor or dermatologist must see certain signs on your skin.

In summary, the major diagnostic features of Atopic Dermatitis are:

  • The typical skin signs
  • a Personal or family history Atopic Dermatitis, Asthma or Hay fever
  • Itching
  • Chronicity of the condition

The typical skin signs of Atopic dermatitis varies with age. In infants the face, scalp, front part of the legs and back part of the arms are most often affected. In adults the disease seems to switch to the opposite side of the limbs where it is the back part of the legs (especially the skin folds behind the knee), the front part of the arms (especially the skin folds at the elbow) and other flexural areas that are characteristically affected. These are not hard-and-fast rules and any area of the skin can be affected.

In addition to the above mentioned major features of Atopic Dermatitis the following minor features can also help in making the diagnosis of Atopic Dermatitis.

  • Xerosis (Skin dryness)
  • Denny-Morgan skin folds. These are prominent skin folds in the lower eyelid.
  • Centro-facial pallor. The skin of the central part of the face appears lighter than the periphery.
  • Peri-orbital darkening. Darkening of the skin around the eyes.
  • Pityriasis alba (a slight powdery-white scaling on the cheeks)
  • Keratosis Pilaris, which can be felt as a roughness on the upper-outer arms especially.
  • a Raised IgE – antibody level on a blood test
  • an Increased number of eosinophils (a type of white blood cell) in the blood
  • Seasonality of the condition
  • a Positive skin prick test to various substances
  • Itching when sweating
  • Prominent skin folds along the front of the neck
  • Prominent dryness on the shins that can have a puzzle-like appearance due to large dry flakes
  • Hand en foot dermatitis
  • Nipple dermatitis
  • Red inflamed eyes
  • Cataracts
  • A sensitivity to wool

Please note that blood tests and skin prick tests cannot be used to diagnose Atopic Dermatitis! They make up just 3 of the minor features of Atopic Dermatitis and are therefore relatively unimportant when it comes to diagnosing Atopic Dermatitis.

It is important to realize that not any single factor alone are diagnostic of Atopic dermatitis. The diagnoses can be made with confidence only if at least 3 of the 4 major features are present together with 3 of the minor features of Atopic Dermatitis.

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I have eczema. I am fed up with applying cream! Now what?

First, relax….

No, eczema can’t be cured. Yes, there is a chance you can have eczema for life. Yes, you might have to apply creams for perhaps the rest of your life! And yes, you do have one of the most frustrating conditions there is.

Please, have your moments of despair, but never, never, never stop using your moisturizers! They are the single most important tool in your eczema treatment toolbox! They are without side effects in most people and can make a major difference to the control of dermatitis by simply keeping skin well hydrated.

Moisturizers are the most important tool in your treatment toolbox

By hydrating your skin the best you can, you will also use less immunosuppressant creams and ointments like corticosteroids, Tacrolimus and Pimecrolimus. Less immunosuppressant medication means there is less chance of getting the side effects of these medications like skin thinning (corticosteroids), infections and even the small unproven possibility of skin cancers (Tacrolimus and Pimecrolimus).

If you do not apply your moisturizers religiously, the whole emphasis of your treatment will start shifting toward immunosuppression. If you were someone who controlled your eczema with emollients and intermittent corticosteroids you will find that you need more corticosteroids. Some people will need treatment with light therapy and a few people might need immunosuppressive tablets. Light therapy raises the chances of skin cancer and most immunosuppressive tablets raises the chances of skin and other cancers.

There are many different emollients on the market. Experiment! Find one you like and stick with it! Use it head-to-toe at least twice a day. Use it even if your skin looks perfect to you. Remember, the goal of using emollients is not only to sooth active eczema, but also to prevent flare-ups from occurring!

Get fed up, feel despair, feel frustrated and then just start applying the emollients again and again…….!

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