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Diagnosis atopic dermatitis

The diagnosis of atopic dermatitis can be made by a GP, a paediatrician and/or a dermatologist.  The main symptom of the condition is the severely itchy skin accompanied by the following symptoms:

  • Dry, pale and inflamed skin.
  • Typical distribution of the inflammatory hotspots on the body. In the severe cases, the inflammation can cover the entire surface of the skin.
  • A chronic course: the illness goes into remission but flares up again periodically.
  • Family history of atopy.
  • White dermographism (a local skin reaction in the form of a white stripe that becomes visible on the skin after stroking with a finger or a blunt objects), the Dennie-Morgan fold (a fold in the skin below the lower eyelid) and orbital darkening, dark circles around the eyes caused by hyperpigmentation after an inflammation.6

It’s not easy to be diagnosed with atopic dermatitis because the “skin” condition is one of the severest of its kind. There are different criteria used for making the diagnosis. The internationally most recognised are the ones put forward by Jon Hanifin and Georg Rajka in 1980. The patient with atopic dermatitis must have 3 basic and 3 minor features associated with the condition.5,13,23

Table: The Hanifin and Rajka diagnostic criteria for atopic dermatitis.
Basic features:
Minor features:
  • Itchy skin
  • Typical morphology and distribution of the skin changes
  • Chronic or chronically relapsing dermatitis
  • Personal or family history of atopy
  • Dry skin.
  • Cracked skin below the ear lobes.
  • Ichthyosis.
  • The Dennie-Morgan fold.
  • Elevated levels of serum IgE antibodies.
  • Early age of onset.
  • Tendency towards secondary skin infections.
  • Itchy skin when sweating.
  • Intolerance to wool and food.
  • White dermographism.
  • Positive skin prick tests for food and/or inhaled allergens.
  • Worsening of the condition in the presence of stress.
  • Hand and foot dermatitis.
  • Orbital darkening.
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    The Hanifin and Rajka criteria suggest that atopic dermatitis may not manifest itself as itchy skin (only 3 major features are necessary for the diagnosis), but it is exactly this symptom as well as the typical distribution of eczema that are the hallmarks of the condition and should never be neglected.8,12 For this reason, other criteria that focus on itchy skin as the primary symptom, such as the criteria of the British Association of Dermatologist5 and the Japanese Dermatological Association,12 should also be considered when making the diagnosis.

    After receiving the diagnosis, patients must also undergo in vitro (the serum IgE antibody levels test and other tests) and in vivo (PRICK, PATCH, provocation and other tests) diagnostic procedures and have their family history examined for the presence of atopic conditions.