How can I differentiate between atopic eczema and other types of dermatitis in a primary care setting?

In a primary care setting, differentiating atopic eczema from other types of dermatitis involves taking a comprehensive clinical and drug history ². This history should include details about the time of onset, pattern, and severity of the eczema, as well as the response to previous and current treatments ². It is also important to inquire about possible trigger factors (irritant and allergic), the impact on the child and their parents or carers, dietary history, growth and development, and personal or family history of atopic conditions ².

A diagnosis of atopic eczema can be made when a child presents with an itchy skin condition along with three or more of the following criteria:

• Visible flexural dermatitis involving skin creases, such as the bends of the elbows or behind the knees ². In children aged 18 months or under, this may present as visible dermatitis on the cheeks and/or extensor areas ².
• Previous flexural dermatitis, or dermatitis on the cheeks and/or extensor areas in children aged 18 months or under ².
• Dry skin in the last 12 months ².
• A personal history of asthma or allergic rhinitis ². For children under 4 years, a history of atopic disease in a first-degree relative can be considered ².
• Onset of signs and symptoms under the age of 2 years (this criterion should not be used in children aged under 4 years) ².

It is important to note that in Asian, Black Caribbean, and Black African children, atopic eczema may affect the extensor surfaces rather than the flexures, and discoid (circular) or follicular (around hair follicles) patterns may be more common ².