Which clinical history findings are characteristic of atopic dermatitis (AD)?

Updated: Apr 26, 2021
  • Author: Cassandra Bradby, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The hallmarks of atopic dermatitis are intense pruritus, chronic eczematous skin lesions, and epidermal thickening and hypertrophy.

The emergency physician often is the first to diagnose atopic dermatitis. The most common presentation is that of infants, usually younger than 6 months, brought in by their parents for a persistent rash. Before coming to the ED, the parents may have tried a number of over-the-counter and home remedies. Parents usually report that the rash has waxed and waned for months with a history of dry skin since birth.

Clinicians should inquire about a family history of asthma, hay fever, allergy, and other atopic diseases. Patients with pertinent medical or family history of such disease tend to have a worse prognosis.

Parents may also give a history of poor sleep or increased irritability in the patients, which is due to the desire to scratch the skin during sleep. Atopic dermatitis begins with intense pruritus, leading the patient to scratch, which results in the characteristic rash.

Atopic dermatitis typically is not associated with fever or other constitutional symptoms, and the presence of these should prompt the clinician to look for bacterial superinfection.

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