The diagnosis is made mostly on clinical grounds and personal (or)
family history of atopy.
A number of inflammatory skin diseases Immuno deficiencies, skin
malignancies, genetic disorders, Infections disease and infestations share
symptoms and signs with AD and should be considered and excluded
before a diagnosis of AD is established.
Wiskott-Aldrich syndroms is an X-linked recessive disorder,
associated with thrombocytopenia, Immune defects and recurrent severe
bacterial infections, characterized by a rash almost indistinguishable from
The hyper IgE syndrome is characterized by markedly elevated
serum IgE levels, recurrent deep seated bacterial infections chronic
dermatitis and reclacitrant dermatophytosis.
Most patients can be made to recovers exposures to the causative
agents are prevented.
The child should be bathed once or twice in a day using very small
quantity of soap or non-soap cleanser in bath water. This is done to
prevent drying of epidermis. After bath, he should be palled dry with
towel and emollients and topical medication should be applied on the still
Systemic antibiotics should be given for 7-10 days to treat
Antinistamins relieve itching and also help in relieving the
inflammation. Systemic steroid therapy is not advisable.
Allergen exacerbating the lesion should be avoided.
Supplementation of diet with large amounts of fish oil containing omega
– 3 fatty acids show favourable results.
AD is associated with recurrent viral skin infections. The most
serious viral infection is “Kaposi varicelli from eruption or eczema
herpecticm”, which is caused by HSV and affects patients of all ages.
After an incubation period of 5-12 days, multiple, itchy, vesiculopustulus
lesions erupt in a disseminated pattern, the vesicular lesions are
umbilicated, tend to crop, and often become haemorrhagic and crusted.
Persons with AD are susceptible to “eczema vaccination” caused
by Variola virus (small pox), which is similar in appearance to eczema
herpeticum and historically follows small pox vaccination or exposure to
individuals vaccinated with small pox.
Staphylococcus aureus is found on over 90% of AD skin lesions.
Honey coloured crusting, folliculitis, impetigo and pyoderma are
indicators of S. aureus.
Patients with extensive skin involvement may develop exfoliative
Eyelid dermatitis and chronic blepharitis may result in visual
impairment from corneal scaring.
Atopic keratoconjunctivitis is usually bilateral and can have
disabling symptoms that include itching, burning, tearing and copious
mucoid discharge. Keratoconus is conical deformity of the cornea
believed to result from chronic rubbing of the eyes in-patients with AD.