The Lancet
Volume 387, Issue 10023, 1218 March 2016, Pages 1109-1122
Atopic dermatitis

StephanWeidingerMD fNatalijaNovakMDb

 

Table. Common differential diagnosis of atopic dermatitis

  Main age group affected Frequency* Characteristics and clinical features
Other types of dermatitis
Seborrhoeic dermatitis Infants Common Salmon-red greasy scaly lesions, often on the scalp (cradle cap) and napkin area; generally presents in the first 6 weeks of life; typically clears within weeks
Seborrhoeic dermatitis Adults Common Erythematous patches with yellow, white, or grayish scales in seborrhoeic areas, particularly the scalp, central face, and anterior chest
Nummular dermatitis Children and adults Common Coin-shaped scaly patches, mostly on legs and buttocks; usually no itch
Irritant contact dermatitis Children and adults Common Acute to chronic eczematous lesions, mostly confined to the site of exposure; history of locally applied irritants is a risk factor; might coexist with atopic dermatitis
Allergic contact dermatitis Children and adults Common Eczematous rash with maximum expression at sites of direct exposure but might spread; history of locally applied irritants is a risk factor; might coexist with atopic dermatitis
Lichen simplex chronicus Adults Uncommon One or more localised circumscribed lichenified plaques that result from repetitive scratching or rubbing because of intense itch
Asteatotic eczema Adults Common Scaly, fissured patches of dermatitis overlying dry skin, most often on lower legs
Infectious skin diseases
Dermatophyte infection Children and adults Common One or more demarcated scaly plaques with central clearing and slightly raised reddened edge; variable itch
Impetigo Children Common Demarcated erythematous patches with blisters or honey-yellow crusting
Scabies Children Common Itchy superficial burrows and pustules on palms and soles, between fingers, and on genitalia; might produce secondary eczematous changes
Congenital immunodeficiencies
Hyper-IgE syndrome Infants Rare Pustular and eczematous rashes within first weeks of life; staphylococcal infections of the skin, sinuses, and lungs; high serum IgE; eosinophilia
Wiskott-Aldrich syndrome Infants Very rare Rash identical to that of atopic dermatitis, usually in first weeks of life in boys; microthrombocytopenia
Omenn syndrome Infants Very rare Early-onset erythroderma, diffuse scaly rash, and chronic diarrhoea
Keratinisation disorders
Ichthyosis vulgaris Infants and adults Uncommon Dry skin with fine scaling, particularly on the lower abdomen and extensor areas; perifollicular skin roughening; palmar hyperlinearity; full form (ie, 2 FLG mutations) is uncommon; often coexists with atopic dermatitis
Netherton syndrome Infants and adults Very rare Eczematous lesions spread over the skin in a serpiginous linear pattern with double-edged scales; hair shaft anomalies (bamboo hair); increased IgE; eosinophilia
Nutritional deficiency
Zinc deficiency Children Uncommon Erythematous scaly patches and plaques most often around the mouth and anus; rare congenital form accompanied by diarrhoea and alopecia
Neoplastic disease
Cutaneous T-cell lymphoma Adults Uncommon Erythematous pink-brown macules and plaques with a fine scale; poorly responsive to topical steroids; variable itch (in early stages)

 

FLG=filaggrin.

 

*

Common=roughly 1 in 10 to 1 in 100; uncommon=roughly 1 in 100 to 1 in 1000; rare=roughly 1 in 1000 to 1 in 10 000; very rare=less than 1 in 10 000.

Especially in developing countries.