Atopic dermatitis differential diagnosis: Difference between revisions
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* Dissociative disturbances | * Dissociative disturbances | ||
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! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]] | ! align="center" style="background:#DCDCDC;" |[[Ichthyosis vulgaris]]<ref name="pmid23301728">{{cite journal |vauthors=Thyssen JP, Godoy-Gijon E, Elias PM |title=Ichthyosis vulgaris: the filaggrin mutation disease |journal=Br. J. Dermatol. |volume=168 |issue=6 |pages=1155–66 |date=June 2013 |pmid=23301728 |doi=10.1111/bjd.12219 |url=}}</ref> | ||
| align="center" style="background:#F5F5F5;" | | |||
* Loss of function mutations in the filaggrin gene (''FLG'') | |||
| | * Autosomal dominant inheritance with incomplete penetrance | ||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Usually in infancy | |||
| | | align="center" style="background:#F5F5F5;" | | ||
* Dry and cold weather | |||
| | * Increased risk of atopic diseases including asthma, alllergic rhinitis and atopic dermatitis | ||
| | | align="center" style="background:#F5F5F5;" | Multiple | ||
| | | align="center" style="background:#F5F5F5;" | | ||
* Xerosis and gray scaling | |||
| align="center" style="background:#F5F5F5;" | | * Palmar hyperlinearity | ||
* Keratosis pilaris | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
* Extensor surfaces of the extremities | |||
* Scalp | |||
* Trunk | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | | |||
* Scales can vary from mild scaling to large, plate (armor)-like scales and thickening of the skin. | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | | |||
* Reduced keratohyalin granules | |||
* Perinuclear keratin retractions in granular cells | |||
* Thick stratum corneum | |||
* Basket-weave pattern of stratum corneum | |||
| align="center" style="background:#F5F5F5;" | Clinical manifestation | |||
| align="center" style="background:#F5F5F5;" | | |||
* Increased risk for atopy, including asthma, allergies, and atopic dermatitis | |||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis]] | ! align="center" style="background:#DCDCDC;" |[[Nummular dermatitis|Nummular dermatitis (discoid eczema)]] | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | Unknown | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | Any, two peaks, 6th-7th decade of life in males and 2nd-3rd decade of life in females | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | ** Temperature changes | ||
| align="center" style="background:#F5F5F5;" | | ** Stress | ||
| align="center" style="background:#F5F5F5;" | | ** Dry skin | ||
| align="center" style="background:#F5F5F5;" | | ** Environmental irritants | ||
| align="center" style="background:#F5F5F5;" | | ** Recent surgery | ||
| align="center" style="background:#F5F5F5;" | | ** Medications like topical antibiotic creams and isotretinoin | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | Multiple | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | * Acute phase: | ||
| align="center" style="background:#F5F5F5;" | | ** Highly pruritic, round | ||
| align="center" style="background:#F5F5F5;" | | ** Coin-shaped patches of erythematous-to-violaceous papules or vesicles | ||
| align="center" style="background:#F5F5F5;" | | * Chronic phase: | ||
| align="center" style="background:#F5F5F5;" | | ** Dry and scaly plaques | ||
| align="center" style="background:#F5F5F5;" | | ** Violaceous and crusty plaques | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | * Upper extremities | ||
| align="center" style="background:#F5F5F5;" | | * Lower extremities | ||
| align="center" style="background:#F5F5F5;" | | * Lower trunk | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | + | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | – | ||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | – | |||
| align="center" style="background:#F5F5F5;" | | |||
* Chronically lesions result into central clearing leading to annular lesions. | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | | |||
* Spongiosis | |||
* Perivascular lymphocytic infiltrates, with eosinophils and occasional neutrophils | |||
| align="center" style="background:#F5F5F5;" | Clinical manifestation | |||
| align="center" style="background:#F5F5F5;" | | |||
* Superinfection with ''staphylococcus aureus'' | |||
* | |||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]] | ! align="center" style="background:#DCDCDC;" |[[Netherton's syndrome]] |
Revision as of 16:38, 23 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Differentiating Atopic Dermatitis from other Diseases
Category | Diseases | Etiology | Inherited | Acquired | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Demography | History | Symptoms | Physical examination | |||||||||||||||||||||||||
Lab Findings | Imaging | Histopathology | ||||||||||||||||||||||||||
Appearance | Itching | Bleeding | Fever | BP | Tenderness | Nail pitting | Other | CBC | ESR/CRP | Electrolytes | BUN/Cr | LFT | ||||||||||||||||
Single/
Multiple |
Rash | Involved areas | Pustule | WBC | Hb | Plt | ||||||||||||||||||||||
Skin disorders | Atopic dermatitis |
| ||||||||||||||||||||||||||
Allergic contact dermatitis[1] |
|
– | + | Any |
|
May be multiple after 1-2 days of exposure | Erythematous well-demarcated papules | Surrounding the area in contact with the offending agent | – | + | – | – | Nl | + | – |
|
Nl to ↑
(Eosinophilia) |
Nl | Nl | Nl | Nl | Nl | Nl | NA | NA | Clinical manifestation + patch test |
| |
Irritant contact dermatitis[2] |
|
– | + | Any, more occupational exposure |
|
Usually single immediately after the exposure | Well-demarcated red patch with a glazed surface | Any area in contact with the irritant | – | + | – | – | Nl | + | – |
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl | NA |
|
Clinical manifestation + patch test |
| |
Seborrheic dermatitis |
|
– | + | Any, onset during the 1st days or weeks of life |
|
Greasy scaling on a yellow-red base | Scalp, axilla, and diaper area | – | ||||||||||||||||||||
Psoriasis |
|
+ | + | Any, 2 peaks of onset 30-39 years and 50-59 years |
|
Multiple | Well-circumscribed, pink papules and symmetrically distributed cutaneous plaques with silvery scales |
|
+ | + | +
Auspitz sign (pinpoint bleeding) |
_ | Nl | + | + | |||||||||||||
Lichen simplex [3]chronicus |
|
– | + | Any, peak at 30-50 years of age |
|
Multiple | Lichenified and erythematous, pruritic exudative plaque, and excoriations | Scalp, head, neck, hands, arms, and genitals areas | – | + | – | – | Nl | – | – |
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl |
|
Clinical manifestation |
| |
Ichthyosis vulgaris[4] |
|
+ | + | Usually in infancy |
|
Multiple |
|
|
– | – | – | – | Nl | – | – |
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl |
|
Clinical manifestation |
| |
Nummular dermatitis (discoid eczema) | Unknown | – | + | Any, two peaks, 6th-7th decade of life in males and 2nd-3rd decade of life in females |
|
Multiple |
|
|
– | + | – | – | Nl | – | – |
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl |
|
Clinical manifestation |
| |
Netherton's syndrome | ||||||||||||||||||||||||||||
Dubowitz syndrome | ||||||||||||||||||||||||||||
Erythrokeratodermia variabilis | ||||||||||||||||||||||||||||
Diseases | Etiology | Inherited | Acquired | Demography | History | Single/
Multiple |
Rash | Involved areas | Pustule | Itching | Bleeding | Fever | BP | Tenderness | Nail pitting | Other | WBC | Hb | Plt | ESR/CRP | Electrolytes | BUN/Cr | LFT | Imaging | Histopathology | Gold standard | Additional findings | |
Infection | Dermatophytes | |||||||||||||||||||||||||||
Candida | ||||||||||||||||||||||||||||
Herpes simplex | ||||||||||||||||||||||||||||
Staphylococcus aureus | ||||||||||||||||||||||||||||
Molluscum contagiosum | ||||||||||||||||||||||||||||
Scabies |
|
Multiple | Erythematous papular lesions | Flexor wrists, finger webs and genitalia | +++ | |||||||||||||||||||||||
HIV | ||||||||||||||||||||||||||||
Diseases | Etiology | Inherited | Acquired | Demography | History | Single/
Multiple |
Rash | Involved areas | Pustule | Itching | Bleeding | Fever | BP | Tenderness | Nail pitting | Other | WBC | Hb | Plt | ESR/CRP | Electrolytes | BUN/Cr | LFT | Imaging | Histopathology | Gold standard | Additional findings | |
Immunologic disorders | Dermatitis herpetiformis | |||||||||||||||||||||||||||
Pemphigus foliaceus | ||||||||||||||||||||||||||||
Graft-versus-host disease | ||||||||||||||||||||||||||||
Dermatomyositis | ||||||||||||||||||||||||||||
Immune deficiency | Wiskott-Aldrich syndrome | |||||||||||||||||||||||||||
Hyper-IgE syndrome | ||||||||||||||||||||||||||||
DiGeorge syndrome | ||||||||||||||||||||||||||||
Severe combined immunodeficiency (SCID) | ||||||||||||||||||||||||||||
Ataxia telangiectasia | ||||||||||||||||||||||||||||
Diseases | Etiology | Inherited | Acquired | Demography | History | Single/
Multiple |
Rash | Involved areas | Pustule | Itching | Bleeding | Fever | BP | Tenderness | Nail pitting | Other | WBC | Hb | Plt | ESR/CRP | Electrolytes | BUN/Cr | LFT | Imaging | Histopathology | Gold standard | Additional findings | |
Metabolic Diseases | Phenylketonuria | |||||||||||||||||||||||||||
Tyrosinemia | ||||||||||||||||||||||||||||
Histidinemia | ||||||||||||||||||||||||||||
Multiple carboxylase deficiency | ||||||||||||||||||||||||||||
Nutritional deficiencies | Zinc deficiency | |||||||||||||||||||||||||||
Niacin (B3) deficiency | ||||||||||||||||||||||||||||
Pyridoxine (B6) deficiency | ||||||||||||||||||||||||||||
Biotin (B7) deficiency | ||||||||||||||||||||||||||||
Malignancy | Mycosis fungoides | |||||||||||||||||||||||||||
Histiocytosis X | ||||||||||||||||||||||||||||
Medications | Infliximab | |||||||||||||||||||||||||||
Category | Diseases | Etiology | Inherited | Acquired | Demography | History | Single/
Multiple |
Rash | Involved areas | Pustule | Itching | Bleeding | Fever | BP | Tenderness | Nail pitting | Other | WBC | Hb | Plt | ESR/CRP | Electrolytes | BUN/Cr | LFT | Imaging | Histopathology | Gold standard | Additional findings |
References
- ↑ Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF (2009). "Allergic and irritant contact dermatitis". Eur J Dermatol. 19 (4): 325–32. doi:10.1684/ejd.2009.0686. PMID 19447733.
- ↑ Bains SN, Nash P, Fonacier L (October 2018). "Irritant Contact Dermatitis". Clin Rev Allergy Immunol. doi:10.1007/s12016-018-8713-0. PMID 30293200.
- ↑ Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U, Lotti J, França K, Batashki A, Tchernev G (July 2017). "Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade". Open Access Maced J Med Sci. 5 (4): 556–557. doi:10.3889/oamjms.2017.133. PMC 5535688. PMID 28785363.
- ↑ Thyssen JP, Godoy-Gijon E, Elias PM (June 2013). "Ichthyosis vulgaris: the filaggrin mutation disease". Br. J. Dermatol. 168 (6): 1155–66. doi:10.1111/bjd.12219. PMID 23301728.