Dr Jason Ezra Hawkes on Diagnostic Challenges, Strategies in Atopic Dermatitis

The lack of biomarkers to distinguish atopic dermatitis (AD) from other similar conditions such as psoriasis can impede diagnosis, but there are several clinical features that primary care providers and dermatologists should look for when screening for the disease, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.

Transcript

What are some challenges regarding screening for AD and how can clinicians improve their diagnostic strategies?

When I think about AD and approaching it in the clinic, I'm really thinking about an approach to rashes. As I work closely with primary care, I see eczema misdiagnosed all the time as fungal infection, allergic contact dermatitis, or there's a whole host of other things. So, I think it's important as you approach any rash that you keep an open mind with differential diagnosis.

One of the things that helps me with patients with eczema is to really get some history as to other conditions, comorbidities that they might have that sort of help maybe push me a little bit more towards AD. So, again, seasonal allergies, hypersensitivity to bites, asthma, itching, other family members who have had eczema, those are things that definitely help from the history side.

From the clinical side, we have the very classic type of eczema that involves flexural surfaces, eyelids, upper eyelids are very common, hand dermatitis, especially with fissures along the sides of the fingers. Those can be really kind of good clues as to this being eczema vs another condition. Typical eczema will kind of get worse in the winter, or the colder months, but you will see other types like dyshidrotic eczema on the hand where they get small blisters, which is usually worse in the hotter months.

So, I think you have to sort of approach this systematically and think about other conditions that can mimic it. Even though we know a lot about eczema, we just really don't have consistent biomarkers of disease, which makes it challenging to make a diagnosis. Sometimes it's a little trial and error, and this is one thing that we're going to have to work on over time, especially because biopsies don't distinguish consistently between eczema and other things like psoriasis. So, we really need to rely on our clinical skills as we approach rashes.