GPAtlas🧭 When to suspect
Atopic eczema (atopic dermatitis) is a common, chronic, relapsing, inflammatory skin condition driven by skin-barrier dysfunction (often linked to filaggrin mutations) and immune dysregulation. Suspect it in a patient with itchy skin together with visible eczema – erythema, dryness, scaling and excoriation. Itch is the cardinal feature: a condition with no itch is unlikely to be atopic eczema.
Distribution is age-dependent and a key clue: in infants it affects the face and extensor surfaces; in older children and adults it is classically flexural (antecubital and popliteal fossae, wrists, ankles, neck). It can, however, affect any site. A personal or family history of atopy (eczema, asthma, allergic rhinitis) is common.
Appearances differ in skin of colour: erythema can look violaceous, grey or brown and is easily missed, and follicular or discoid (coin-shaped) patterns are more common. Standard severity scores may underestimate disease in darker skin, so weight the history and impact heavily.
| Diagnostic framework | Detail |
|---|---|
| Essential criterion | An itchy skin condition (or parental report of scratching/rubbing). |
| Plus three or more of | • Visible flexural dermatitis (or cheeks/extensors if ≤ 18 months) • History of flexural involvement (or cheeks/extensors if ≤ 18 months) • History of dry skin in the last 12 months • Personal history of asthma or allergic rhinitis (or atopy in a first-degree relative if the child is < 4 years) • Onset under 2 years (not used in children < 4 years) |
Source: NICE CG57 · DermNet
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