Atopic dermatitis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Atopic dermatitis}}
 
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}
== Overview ==
== Overview ==
Due to the variable morphology, distribution of skin lesions and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
* Atopic dermatitis is primarily diagnosed based on the clinical presentation.


=== Study of choice ===
* There is no single diagnostic study of choice for routinely diagnosis of atopic dermatitis, but in selected patients,to rule out other skin conditions, histology examination of a skin biopsy and other laboratory tests (eg, serum immunoglobulin E, potassium hydroxide preparation, patch testing, genetic testing) can be considered.<ref name="pmid242904312">{{cite journal |vauthors=Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R |title=Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=70 |issue=2 |pages=338–51 |date=February 2014 |pmid=24290431 |pmc=4410183 |doi=10.1016/j.jaad.2013.10.010 |url=}}</ref>
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]


=== Name of Diagnostic Criteria ===
=== Diagnostic Criteria: ===
* Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest diagnostic criteria is the 1980 Hanifin and Rajka criteria<ref name="urlCiNii 論文 -  Diagnostic features of atopic dermatitis">{{cite web |url=https://ci.nii.ac.jp/naid/10005197286/ |title=CiNii 論文 -  Diagnostic features of atopic dermatitis |format= |work= |accessdate=}}</ref><ref name="pmid16086748">{{cite journal |vauthors=Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE |title=A comparison between criteria for diagnosing atopic eczema in infants |journal=Br. J. Dermatol. |volume=153 |issue=2 |pages=352–8 |date=August 2005 |pmid=16086748 |doi=10.1111/j.1365-2133.2005.06491.x |url=}}</ref>
* Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest diagnostic criteria is the 1980 Hanifin and Rajka criteria<ref name="urlCiNii 論文 -  Diagnostic features of atopic dermatitis">{{cite web |url=https://ci.nii.ac.jp/naid/10005197286/ |title=CiNii 論文 -  Diagnostic features of atopic dermatitis |format= |work= |accessdate=}}</ref><ref name="pmid16086748">{{cite journal |vauthors=Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE |title=A comparison between criteria for diagnosing atopic eczema in infants |journal=Br. J. Dermatol. |volume=153 |issue=2 |pages=352–8 |date=August 2005 |pmid=16086748 |doi=10.1111/j.1365-2133.2005.06491.x |url=}}</ref>
* The most used criteria worldwide is published by United Kingdom working group and is based upon history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.<ref name="pmid24290431">{{cite journal |vauthors=Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R |title=Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=70 |issue=2 |pages=338–51 |date=February 2014 |pmid=24290431 |pmc=4410183 |doi=10.1016/j.jaad.2013.10.010 |url=}}</ref>
* The most used criteria worldwide is published by United Kingdom working group and is based upon history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.<ref name="pmid24290431">{{cite journal |vauthors=Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R |title=Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis |journal=J. Am. Acad. Dermatol. |volume=70 |issue=2 |pages=338–51 |date=February 2014 |pmid=24290431 |pmc=4410183 |doi=10.1016/j.jaad.2013.10.010 |url=}}</ref>
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|Adapted from U.K. Working Party's Diagnostic Criteria  
|Adapted from U.K. Working Party's Diagnostic Criteria  
|}
|}
* The best basis for making decisions about treatment depends upon<ref name="pmid10730763">{{cite journal |vauthors=Emerson RM, Charman CR, Williams HC |title=The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading |journal=Br. J. Dermatol. |volume=142 |issue=2 |pages=288–97 |date=February 2000 |pmid=10730763 |doi= |url=}}</ref>
** presence or absence of sleep disturbance
** number and location of involved sites
** clinical course of the disease


==References==
==References==

Revision as of 15:43, 11 October 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Due to the variable morphology, distribution of skin lesions and intermittent clinical features, it is very challenging to define the diagnosis of atopic dermatitis.

Diagnostic Study of Choice

  • Atopic dermatitis is primarily diagnosed based on the clinical presentation.
  • There is no single diagnostic study of choice for routinely diagnosis of atopic dermatitis, but in selected patients,to rule out other skin conditions, histology examination of a skin biopsy and other laboratory tests (eg, serum immunoglobulin E, potassium hydroxide preparation, patch testing, genetic testing) can be considered.[1]

Diagnostic Criteria:

  • Atopic dermatitis is primarily diagnosed based on clinical presentation. There are several established criteria for the diagnosis of atopic dermatitis, the earliest diagnostic criteria is the 1980 Hanifin and Rajka criteria[2][3]
  • The most used criteria worldwide is published by United Kingdom working group and is based upon history, morphology and distribution of eczematous lesions, and clinical features of atopic dermatitis.[4]
  • United Kingdom working group criteria includes one mandatory and 3 or more from the 5 major criteria.[5]
Atopic dermatitis diagnostic criteria
  • Mandatory criteria:[5]
    • Evidence of pruritus or report of scratching or rubbing by the parent
  • 3 or more of the major criteria:[5]
    • History of skin creases involvement including areas around neck and eyes, front of ankles, front of elbows and back of knees.
    • History of asthma or hay fever( if children <4 years of age - history of atopic disease in a first-degree relative)
    • History of presence of generally dry skin in the past year.
    • The onset of symptoms in child <2 years of age. This criterion is not recommended if child <4 years old.
    • Visible dermatitis including flexor surfaces. In children <4 years of age, the criterion can involve dermatitis affecting the cheeks or forehead and outer aspects of the extremities.
Adapted from U.K. Working Party's Diagnostic Criteria
  • The best basis for making decisions about treatment depends upon[6]
    • presence or absence of sleep disturbance
    • number and location of involved sites
    • clinical course of the disease

References

  1. ↑ Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R (February 2014). "Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis". J. Am. Acad. Dermatol. 70 (2): 338–51. doi:10.1016/j.jaad.2013.10.010. PMC 4410183. PMID 24290431.
  2. ↑ "CiNii 論文 -  Diagnostic features of atopic dermatitis".
  3. ↑ Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE (August 2005). "A comparison between criteria for diagnosing atopic eczema in infants". Br. J. Dermatol. 153 (2): 352–8. doi:10.1111/j.1365-2133.2005.06491.x. PMID 16086748.
  4. ↑ Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R (February 2014). "Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis". J. Am. Acad. Dermatol. 70 (2): 338–51. doi:10.1016/j.jaad.2013.10.010. PMC 4410183. PMID 24290431.
  5. ↑ 5.0 5.1 5.2 Williams HC, Burney PG, Pembroke AC, Hay RJ (September 1994). "The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation". Br. J. Dermatol. 131 (3): 406–16. PMID 7918017.
  6. ↑ Emerson RM, Charman CR, Williams HC (February 2000). "The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading". Br. J. Dermatol. 142 (2): 288–97. PMID 10730763.

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