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Clinical Aspects and Diagnosis of Atopic Eczema

  • Matthias Möhrenschlager
  • Stephan Weidinger
  • Johannes Ring
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

Atopic eczema (AE) is characterized by the absence of any specific laboratory test and histopathological finding. In this chapter, the full clinical spectrum of AE is presented. Furthermore, important cutaneous disorders, which have to be delineated are mentioned.

Keywords

Atopic Eczema Skin Prick Testing Allergy Clin Immunol Atopic Eczema Patient World Allergy Organization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Möhrenschlager M, Darsow U, Schnopp C, Ring J (2006) What is new in atopic eczema? JEADV 20:503–511PubMedGoogle Scholar
  2. 2.
    Rudikoff D, Akhavan A, Cohen SR (2003) Color atlas: eczema. Clin Dermatol 21:101–108PubMedCrossRefGoogle Scholar
  3. 3.
    Coca AF, Cooke RA (1923) On the classification of the phenomena of hypersensitiveness. J Immunol 8:163–182Google Scholar
  4. 4.
    Ring J (2005) Allergy in practice. Springer, Berlin, pp. 86–105Google Scholar
  5. 5.
    Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wüthrich B; EAACI (European Academy of Allergology and Cinical Immunology) Nomenclature Task Force (2001) A revised nomenclature for allergy. Allergy 56:813–824PubMedCrossRefGoogle Scholar
  6. 6.
    Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, van Cauwenberge P, Williams HC (2004) Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113:832–836PubMedCrossRefGoogle Scholar
  7. 7.
    Rudikoff D, Lebwohl M (1998) Atopic dermatitis. Lancet 351:1715–1721PubMedCrossRefGoogle Scholar
  8. 8.
    Thestrup-Pedersen K (2000) Clinical aspects of atopic dermatitis. Clin Exp Dermatol 25:535–543PubMedCrossRefGoogle Scholar
  9. 9.
    Hanifin JM (1991) Atopic dermatitis in infants and children. Pediatr Clin North Am 38:763–789PubMedGoogle Scholar
  10. 10.
    Abeck D, Burgdorf W, Cremer H (2003) Common skin diseases in children. Steinkopff, Darmstadt, pp. 19–30Google Scholar
  11. 11.
    Kunz BIF, Ring J (2006) Clinical features and diagnostic criteria of atopic dermatitis. In: Harper J, Oranje A, Prose N (eds.), Textbook of pediatric dermatology (2nd edition). Blackwell, Oxford, pp. 227–244Google Scholar
  12. 12.
    Dotterud LK, Kvammen B, Lund E, Falk ES (1995) Prevalence and some clinical aspects of atopic dermatitis in the community of Sør-Varanger. Acta Derm Venereol (Stockh) 75:50–53Google Scholar
  13. 13.
    Schudel P, Wüthrich B (1985) Klinische Verlaufsbeobachtungen bei Neurodermitis atopica nach dem Kleinkindesalter. Z Hautkr 60:479–486PubMedGoogle Scholar
  14. 14.
    Cowan MA (1961) Nummular eczema: a review, follow up and analysis of a series of 325 cases. Act Derm Venereol (Stockh) 41:453Google Scholar
  15. 15.
    Breit R (1997) Neurodermatitis (Dermatitis atopica) im Kindesalter. Z Hautkr 2(Suppl):72–82Google Scholar
  16. 16.
    Holden CA, Berth-Jones J (2004) Eczema, lichenification, prurigo and erythroderma. In: Burns T, Breathnach S, Cox N, Griffiths C (eds.), Rook's textbook of dermatology (vol. 1) (7th edition). Blackwell, Oxford, pp. 17.1–17.55Google Scholar
  17. 17.
    Neering H, van Dijk E (1978) Juvenile plantar dermatosis. Acta Derm Venereol (Stockh) 58:531–534Google Scholar
  18. 18.
    Kint A, van Hecke E, Leys G (1982) Dermatitis plantaris sicca. Dermatologica 165:500–509PubMedGoogle Scholar
  19. 19.
    Jones SK, English JS, Forsyth A, Mackie RM (1987) Juvenile plantar dermatosis — an 8-year follow-up of 102 patients. Clin Exp Dermatol 12:5–7PubMedCrossRefGoogle Scholar
  20. 20.
    Svensson A, Moiler H (1986) Eyelid dermatitis: the role of atopy and contact allergy. Contact Dermatitis 15:178–182PubMedCrossRefGoogle Scholar
  21. 21.
    Rudzki E, Samochocki Z, Rebandel P, Saciuk E, Galecki W, Raczka A, Szmurlo A (1994) Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis. Dermatology 189:41–46PubMedGoogle Scholar
  22. 22.
    Mevorah B, Frenk E, Wietlisbach V, Carrel CF (1988) Minor clinical features of atopic dermatitis. Dermatologica 177:360–364PubMedGoogle Scholar
  23. 23.
    Diepgen TL, Fartasch M (1992) Recent epidemiological and genetic studies in atopic dermatitis. Acta Derm Venereol (Stockh) 176(suppl):13–18Google Scholar
  24. 24.
    Przybilla B, Ring J, Enders F, Winkelmann H (1991) Stigmata of atopic constitution in patients with atopic eczema or atopic respiratory disease. Acta Derm Venereol (Stockh) 71:407–410Google Scholar
  25. 25.
    Svensson A (1989) Xerosis and a history of dry skin. In: Svensson A (ed.), Diagnosis of atopic skin disease based on clinical criteria. Lund University Press, Kristianstad, pp. 41–43Google Scholar
  26. 26.
    Linde YW (1992) Dry skin in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 177:9–13Google Scholar
  27. 27.
    Werner Y, Lindberg M (1982) The water-binding capacity of stratum corneum in non-ecze-matous skin of atopic eczema. Acta Derm Venereol (Stockh) 62:334–337Google Scholar
  28. 28.
    Eberlein-König B, Schäfer T, Huss-Marp J, Darsow U, Möhrenschlager M, Herbert O, Abeck D, Krämer U, Behrendt H, Ring J (2000) Skin surface pH, stratum corneum hydration, trans-epidermal water loss and skin roughness related to atopic eczema and skin dryness in a population of primary school children. Acta Derm Venereol (Stockh) 80:188–191CrossRefGoogle Scholar
  29. 29.
    Przybilla B, Bauer C (2005) Stigmata of the atopic constitution. In: Ring J, Przybilla B, Ruzicka T (eds.), Handbook of atopic eczema (2nd edition). Springer, Berlin, pp. 61–73Google Scholar
  30. 30.
    Morgan DB (1948) A suggestive sign of allergy. Arch Dermatol Syphol 57:1050–1053Google Scholar
  31. 31.
    Williams HC, Pembroke AC (1996) Infraorbital crease, ethnic group, and atopic dermatitis. Arch Dermatol 132:51–54PubMedCrossRefGoogle Scholar
  32. 32.
    Whitfield A (1938) On the white reaction in dermatology. Br J Dermatol 50:71–76CrossRefGoogle Scholar
  33. 33.
    Aizawa H, Tagami H (1989) Inability to produce white dermographism in the early stage of infantile eczema. Pediatr Dermatol 6:6–9PubMedCrossRefGoogle Scholar
  34. 34.
    Judge MR, McLean WHI, Munro CS (2004) Disorders of keratinization. In: Burns T, Breathnach S, Cox N, Griffiths C (eds.), Rook's textbook of dermatology (vol. 2) (7th edition). Blackwell, Oxford, pp. 34.1–34.111Google Scholar
  35. 35.
    Marks MB (1977) Recognizing the allergic person. Am Fam Physician 16:72–79PubMedGoogle Scholar
  36. 36.
    Hurwitz S (2006) Clinical pediatric dermatology (3rd edition). Elsevier/W.B. Saunders, Philadelphia, pp. 49–64Google Scholar
  37. 37.
    Levy Y, Segal N, Ben-Amitai D, Danon YL (2004) Eyelash length in children and adolescents with allergic disease. Pediatr Dermatol 21:534–537PubMedCrossRefGoogle Scholar
  38. 38.
    Möhrenschlager M, Weidinger S, Huss-Marp J, Krämer U, Behrendt H, Ring J (2005) Do gender-specific differences in eyelash length in 5- to 6-year-old preschool children with and without atopic eczema exist? Results from the MIRIAM study conducted in Augsburg, Germany. Pediatr Dermatol 22:576–577PubMedCrossRefGoogle Scholar
  39. 39.
    Hanifin JM, Rajka G (1980) Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) 92(Suppl):44–47Google Scholar
  40. 40.
    Diepgen TL, Sauerbrei W, Fartasch M (1996) Development and validation of diagnostic scores for atopic dermatitis incorporating criteria of data quality and practical usefulness. J Clin Epidemiol 49:1031–1038PubMedCrossRefGoogle Scholar
  41. 41.
    Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, Bingham EA, Finlay AY, Pembroke AC, Graham-Brown RA (1994) The U.K. working party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol 131:383–396PubMedCrossRefGoogle Scholar
  42. 42.
    Bos JD, van Leent EJ, Sillevis Smitt JH (1998) The millennium criteria for the diagnosis of atopic dermatitis. Exp Dermatol 7:132–138PubMedCrossRefGoogle Scholar
  43. 43.
    Schultz-Larsen F, Hanifin JM (1992) Secular change in the occurrence of atopic dermatitis. Acta Derm Venereol (Stockh) 176(suppl):7–12Google Scholar
  44. 44.
    Svensson A, Edman B, Möller H (1985) A diagnostic tool for atopic dermatitis based on clinical criteria. Acta Derm Venereol (Stockh) 114(suppl):33–40Google Scholar
  45. 45.
    Visscher MO, Hanifin JM, Bowman WJ (1989) Atopic dermatitis and atopy in non-clinical populations. Acta Derm Venereol (Stockh) 144(suppl):34–40Google Scholar
  46. 46.
    Williams HC, Burney PGJ, Strachan D, Hay RJ (1994) The UK working party's diagnostic criteria for atopic dermatitis. II: observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol 131:397–405PubMedCrossRefGoogle Scholar
  47. 47.
    Möhrenschlager M, Schäfer T, Williams HC, von der Werth J, Krämer U, Behrendt H, Ring J (1998) Übersetzung und Validierung der britischen Diagnosekriterien des atopischen Ekzems bei 8- und 9- jährigen Schulkindern in Augsburg. Allergo J 7:373–377Google Scholar
  48. 48.
    European Task Force on Atopic Dermatitis (1993) Severity scoring of atopic dermatitis: the SCORAD index. Dermatology 186:23–31CrossRefGoogle Scholar
  49. 49.
    Yates VM, Kerr REI, MacKie RM (1983) Early diagnosis of infantile seborrhoeic dermatitis and atopic dermatitis-clinical features. Br J Dermatol 108:633–638PubMedCrossRefGoogle Scholar
  50. 50.
    Yates VM, Kerr REI, MacKie RM (1983) Early diagnosis of infantile seborrhoeic dermatitis and atopic dermatitis-total and specific IgE levels. Br J Dermatol 108:639–645PubMedCrossRefGoogle Scholar
  51. 51.
    Prendiville JS (2006) Scabies and lice. In: Harper J, Oranje A, Prose N (eds.), Textbook of pediatric dermatology (2nd edition). Blackwell, Oxford, pp. 659–673Google Scholar
  52. 52.
    Saurat JH (1985) Eczema in primary immune deficiencies. Clues to the pathogenesis of atopic dermatitis with special reference of the Wiskott-Aldrich syndrome. Acta Derm Venereol (Stockh) 114:125–128Google Scholar
  53. 53.
    Plebani A, Ugazio AG, Monafo V (1989) Selective IgA deficiency: an update. Curr Probl Dermatol 18:66–78PubMedGoogle Scholar
  54. 54.
    Buckley RH, Fiscus SA (1975) Serum IgD and IgE concentrations in immunodeficiency diseases. J Clin Invest 55:157–165PubMedCrossRefGoogle Scholar
  55. 55.
    Ring J, Landthaler M (1989) Hyper IgE syndromes. Curr Probl Dermatol 18:79–88PubMedGoogle Scholar
  56. 56.
    Amman AJ (1987) Cutaneous manifestations of immunodeficiency disorders. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF (eds.), Dermatology in general medicine (3rd edition). McGraw-Hill, New York, pp. 2507–2522Google Scholar
  57. 57.
    Möhrenschlager M, Schäfer T, Huss-Marp J, Eberlein-König B, Weidinger S, Ring J, Behrendt H, Krämer U (2006) The course of eczema in children aged 5–7 years and its relation to atopy: differences between boys and girls. Br J Dermatol 154:505–513PubMedCrossRefGoogle Scholar
  58. 58.
    Nelson HS (1995) Clinical application of immediate skin testing. In: Spector SL (ed.), Provocation testing in clinical practice. Marcel Dekker, New York, pp. 703–727Google Scholar
  59. 59.
    Wüthrich B, Fuchs W (1979) Serum IgE levels in atopic diseases in childhood. Helv Paediatr Acta 34:537–544PubMedGoogle Scholar
  60. 60.
    Ahlstedt S (2002) Understanding the usefulness of specific IgE tests in allergy. Clin Exp Allergy 32:11–16PubMedCrossRefGoogle Scholar
  61. 61.
    Yman L (2001) Standardization of in vitro methods. Allergy 56(suppl 67):70–74PubMedCrossRefGoogle Scholar
  62. 62.
    Dolen WK (1999) Skin testing and immunoassays for allergen-specific IgE: a workshop report. Ann Allergy Asthma Immunol 82:407–412CrossRefGoogle Scholar
  63. 63.
    Sanz ML, Prieto I, Garcia BE, Oehling A (1996) Diagnostic reliability considerations of specific IgE determination. J Investig Allergol Clin Immunol 6:152–161PubMedGoogle Scholar
  64. 64.
    Mitchell EB, Crow J, Chapman MD, Jouhal SS, Pope FM, Platts-Mills TAE (1982) Basophils in allergen-induced patch test sites in atopic dermatitis. Lancet 1:127–130PubMedCrossRefGoogle Scholar
  65. 65.
    Ring J, Darsow U, Gfesser M, Vieluf D (1997) The ‘atopy patch test’ in evaluating the role of aeroallergens in atopic eczema. Int Arch Allergy Immunol 113:379–383PubMedCrossRefGoogle Scholar
  66. 66.
    Gondo A, Saeki N, Tokuda Y (1986) Challenge reactions in atopic dermatitis after percutaneous entry of mite antigen. Br J Dermatol 115:485–493PubMedCrossRefGoogle Scholar
  67. 67.
    Bruijnzeel PL, Kuijper PH, Kapp A, Warringa RA, Betz S, Bruijnzeel-Koomen CA (1993) The involvement of eosinophils in the patch test reaction to aeroallergens in atopic dermatitis: its relevance for the pathogenesis of atopic dermatitis. Clin Exp Allergy 23:97–109PubMedCrossRefGoogle Scholar
  68. 68.
    Adinoff AD, Tellez P, Clark RA (1988) Atopic dermatitis and aeroallergen contact sensitivity. J Allergy Clin Immunol 135:182–186Google Scholar
  69. 69.
    Clark RA, Adinoff AB (1989) Aeroallergen contact can exacerbate atopic dermatitis: patch tests as a diagnostic tool. J Am Acad Dermatol 21:863–869PubMedCrossRefGoogle Scholar
  70. 70.
    Imayama S, Hashizume T, Miyahara H, Tanahashi T, Takeishi M, Kubota Y, Koga T, Hori Y, Fukuda H (1992) Combination of patch test and IgE for dust mite antigens differentiates 130 patients with atopic dermatitis into four groups. J Am Acad Dermatol 27:531–538PubMedCrossRefGoogle Scholar
  71. 71.
    Darsow U, Vieluf U, Ring J (1996) The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema. Br J Dermatol 135:182–186PubMedCrossRefGoogle Scholar
  72. 72.
    Darsow U, Vieluf U, Ring J (1999) Evaluating the relevance of aeroallergen sensitization in atopic eczema with the atopy patch test: a randomized, double-blind multicenter study. J Am Acad Dermatol 40:187–193PubMedCrossRefGoogle Scholar
  73. 73.
    Darsow U, Vieluf D, Ring J (1995) Atopy patch test with different vehicles and allergen concentrations: an approach to standardization. J Allergy Clin Immunol 95:677–684PubMedCrossRefGoogle Scholar
  74. 74.
    Darsow U, Ring J (2000) Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 25:544–551PubMedCrossRefGoogle Scholar
  75. 75.
    Bruijnzeel PL, Kuijper PH, Kapp A, Warringa RA, Betz S, Bruijnzeel-Koomen CA (1993) The involvement of eosinophils in the patch test reaction to aeroallergens in atopic dermatitis: its relevance for the pathogenesis of atopic dermatitis. Clin Exp Allergy 23:97–109PubMedCrossRefGoogle Scholar
  76. 76.
    Darsow U, Laifaoui J, Kerschenlohr K, Wollenberg A, Przybilla B, Wüthrich B, Borelli S, Giusti F, Seidenari S, Drzimalla K, Simon D, Disch R, Borelli S, Devillers AC, Oranje AP, de Raeve L, Hachem JP, Dangoisse C, Blondeel A, Song M, Breuer K, Wulf A, Werfel T, Roul S, Taieb A, Bolhaar S, Bruijnzeel-Koomen C, Brönnimann M, Braathen LR, Didierlaurent A, André C, Ring J (2004) The prevalence of positive reactions in the atopy patch test with aer-oallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy 59:1318–1325PubMedCrossRefGoogle Scholar
  77. 77.
    Langeveld-Wildschut EG, van Marion AM, Thepen T, Mudde GC, Bruijnzeel PL, Bruijnzeel-Koomen CA (1995) Evaluation of variables influencing the outcome of the atopy patch test. J Allergy Clin Immunol 96:66–73PubMedCrossRefGoogle Scholar
  78. 78.
    Langeveld-Wildschut EG, Riedl H, Thepen T, Bihari IC, Bruijnzeel PL, Bruijnzeel-Koomen CA (2000) Modulation of the atopy patch test reaction by topical corticosteroids and tar. J Allergy Clin Immunol 106:737–743PubMedCrossRefGoogle Scholar
  79. 79.
    Høst A, Andrae S, Charkin S, Diaz-Vázquez C, Dreborg S, Eigenmann PA, Friedrichs F, Grinsted P, Lack G, Meylan G, Miglioranzi P, Muraro A, Nieto A, Niggemann B, Pascual C, Pouech MG, Rancé F, Rietschel E, Wickman M (2003) Allergy testing in children: why, who, when and how? Allergy 58:559–569PubMedCrossRefGoogle Scholar
  80. 80.
    Darsow U, Ring J (2002) Allergy diagnosis in atopic eczema with the atopy patch test. In: Bieber T, Leung DY (eds.), Atopic dermatitis. Marcel Dekker, New York, pp. 86–105Google Scholar
  81. 81.
    Schultz-Larsen F (1993) Atopic dermatitis: a genetic-epidemiologic study in a population-based twin sample. J Am Acad Dermatol 28:719–723PubMedCrossRefGoogle Scholar
  82. 82.
    Cookson WO, Ubhi B, Lawrence R, Abecasis GR, Walley AJ, Cox HE, Coleman R, Leaves NI, Trembath RC, Mofatt MF, Harper IJ (2001) Genetic linkage of childhood atopic dermatitis to psoriasis susceptibility loci. Nat Genet 27:372–373PubMedCrossRefGoogle Scholar
  83. 83.
    Cookson WO, Moffatt MF (2002) The genetics of atopic dermatitis. Curr Opin Allergy Immunol 2:383–387CrossRefGoogle Scholar
  84. 84.
    Leung DYM, Jain N, Leo HL (2003) New concepts in the pathogenesis of atopic dermatitis. Curr Opin Immunol 15:634–638PubMedCrossRefGoogle Scholar
  85. 85.
    Lee YA, Wahn U, Kehrt R, Tarani L, Businco L, Gustafsson D, Andersson F, Oranje AP, Wolkertstorfer A, von Berg A, Hoffmann U, Küster W, Wienker T, Rüschendorf F, Reis A (2001) A major susceptibility locus for atopic dermatitis maps to chromosome 3q21. Nat Genet 26:470–473CrossRefGoogle Scholar
  86. 86.
    Tamura K, Suzuki M, Arakawa H, Tokuyama K, Morikawa A (2003) Linkage and association studies of STAT6 gene polymorphisms and allergic diseases. Int Arch Allergy Immunol 131:33–38PubMedCrossRefGoogle Scholar
  87. 87.
    Novak N, Kruse S, Kraft S, Geiger E, Klüken H, Fimmers R, Deichmann KA, Bieber T (2002) Dichotomic nature of atopic dermatitis reflected by combined analysis of monocyte immunophenotyping and single nucleotide polymorphisms of the interleukin-4/interleukin-13 receptor gene: the dichotomy of extrinsic and intrinsic atopic dermatitis. J Invest Dermatol 119:870–875PubMedCrossRefGoogle Scholar
  88. 88.
    Arkwright PD, Chase JM, Babbage S, Pravica V, David TJ, Hutchinson IV (2001) Atopic dermatitis is associated with a low-producer transforming growth factor beta(1) cytokine genotype. J Allergy Clin Immunol 108:281–284PubMedCrossRefGoogle Scholar
  89. 89.
    Yagi R, Nagai H, Iigo Y, Akimoto T, Arai T, Kubo M (2002) Development of atopic dermatitis-skin lesions in STAT6-deficient NC/Nga mice. J Immunol 168:2020–2027PubMedGoogle Scholar
  90. 90.
    Weidinger S, O'sullivan M, Illig T, Baurecht H, Depner M, Rodriguez E, Ruether A, Klopp N, Vogelberg C, Weiland SK, McLean WH, von Mutius E, Irvine AD, Kabesch M (2008) Filaggrin mutations, atopic eczema, hay fever, and asthma in children. J Allergy Clin Immunol 121:1203–1209PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Matthias Möhrenschlager
    • 1
  • Stephan Weidinger
    • 1
  • Johannes Ring
    • 1
  1. 1.Division of Environmental Dermatology and Allergology GSF/TUM, Department of Dermatology and Allergy BiedersteinTechnical University of MunichMunichGermany

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