Eczema (Atopic Dermatitis)

🔍 When to Suspect

Itchy skin with a typical flexural distribution in adults or extensor/facial distribution in infants, often with a personal or family history of atopy

From the full topic in The Ocean Library: Eczema (Atopic Dermatitis)

🧭 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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