Atopic dermatitis differential diagnosis: Difference between revisions
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* ↑ serum immunoglobulin E (IgE) levels | * ↑ serum immunoglobulin E (IgE) levels | ||
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyper-IgE syndrome]]<ref name="pmid24058807">{{cite journal |vauthors=Mogensen TH |title=STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties |journal=JAKSTAT |volume=2 |issue=2 |pages=e23435 |date=April 2013 |pmid=24058807 |pmc=3710320 |doi=10.4161/jkst.23435 |url=}}</ref> | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | * Defects in the JAK-STAT signaling pathway leading to dysfunctional T helper cell type 17 (Th17) differentiation | ||
| 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;" | Rare, begin in infancy | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | * Cold abscesses | ||
| align="center" style="background:#F5F5F5;" | | |||
| align="center" style="background:#F5F5F5;" | | * Pruritic eczema | ||
| align="center" style="background:#F5F5F5;" | | * Allergic diseases | ||
| align="center" style="background:#F5F5F5;" | | * Noneruption of permanent teeth | ||
| align="center" style="background:#F5F5F5;" | | * Multiple bone fractures and scoliosisis | ||
| align="center" style="background:#F5F5F5;" | | * Peripheral T-cell lymphoma | ||
| align="center" style="background:#F5F5F5;" | | * Coronary artery aneurysms | ||
| 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;" | | * Papulopustular | ||
| align="center" style="background:#F5F5F5;" | | * Severely pruritic eczematous rash | ||
| align="center" style="background:#F5F5F5;" | | * Pustular and may impetiginized | ||
| align="center" style="background:#F5F5F5;" | | * Lichenification may occur | ||
| align="center" style="background:#F5F5F5;" | | | align="center" style="background:#F5F5F5;" | | ||
| align="center" style="background:#F5F5F5;" | | * Face and scalp | ||
| align="center" style="background:#F5F5F5;" | | * Upper trunk and shoulders | ||
| align="center" style="background:#F5F5F5;" | | * Buttocks | ||
| align="center" style="background:#F5F5F5;" | | * Area behind the ears and around the hairline | ||
| 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;" | | |||
* Characteristic coarse facies | |||
* Increased alar width and broad nasal bridge | |||
* High-arched oral palate | |||
* Hyperextensible joints | |||
| align="center" style="background:#F5F5F5;" | | |||
* ↑ Eosinophilia | |||
| 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;" | | |||
* Eosinophil-rich infiltration around the hair follicles | |||
| align="center" style="background:#F5F5F5;" | Clinical and laboratory findings | |||
| align="center" style="background:#F5F5F5;" | | |||
* ↑ serum immunoglobulin E (IgE) levels | |||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[22q11.2 deletion syndrome|DiGeorge syndrome]] | ! align="center" style="background:#DCDCDC;" |[[22q11.2 deletion syndrome|DiGeorge syndrome]] |
Revision as of 20:08, 23 October 2018
Atopic dermatitis Microchapters |
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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 | Nl |
|
Clinical manifestation |
| |
Netherton's syndrome[5] | Autosomal recessive mutations in the serine protease inhibitor of Kazal type 5 gene (SPINK5), encoding LEKTI, a serine protease inhibitor | + | – | Affects neonates |
|
Multiple |
|
|
+ | + | – | – | Nl | – | – |
|
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl |
|
Clinical manifestation |
| |
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[6] |
|
+ | – | Seen almost exclusively in males in infancy |
|
Multiple |
|
Rash can involve lesions located at the same areas of classical atopic dermatitis:
extensor surfaces of extremities and cheeks or scalp |
– | + | + | – | Nl | – | – | Infants can present with petechiae, prolonged bleeding from umbilicus or circumcision, purpura, hematemesis, melena, epistaxis, hematuria or unusal bruising |
|
Nl | Thrombocytopenia and small platelets | Nl | Nl | Nl | Nl | Nl |
|
Clinical manifestation |
|
Hyper-IgE syndrome[7] |
|
+ | – | Rare, begin in infancy |
|
Multiple |
|
|
+ | + | – | – | Nl | – | – |
|
|
Nl | Nl | Nl | Nl | Nl | Nl | Nl |
|
Clinical and laboratory findings |
| |
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.
- ↑ Chavanas S, Bodemer C, Rochat A, Hamel-Teillac D, Ali M, Irvine AD, Bonafé JL, Wilkinson J, Taïeb A, Barrandon Y, Harper JI, de Prost Y, Hovnanian A (June 2000). "Mutations in SPINK5, encoding a serine protease inhibitor, cause Netherton syndrome". Nat. Genet. 25 (2): 141–2. doi:10.1038/75977. PMID 10835624.
- ↑ Buchbinder D, Nugent DJ, Fillipovich AH (2014). "Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments". Appl Clin Genet. 7: 55–66. doi:10.2147/TACG.S58444. PMC 4012343. PMID 24817816.
- ↑ Mogensen TH (April 2013). "STAT3 and the Hyper-IgE syndrome: Clinical presentation, genetic origin, pathogenesis, novel findings and remaining uncertainties". JAKSTAT. 2 (2): e23435. doi:10.4161/jkst.23435. PMC 3710320. PMID 24058807.