Conditions That May Simulate Atopic Dermatitis

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Seborrheic Dermatitis of Infancy

This eruption is partially eczematous and partially papulosquamous. Onset and distribution are similar to those for infantile atopic dermatitis. Differentiation is particularly difficult when the eczema component is predominant. Both conditions may exhibit heavy scale. While the scale of seborrhea is yellow and greasy, that of atopy is white and dry. The distinction is not always easy to make. Seborrhea lesions tend to have sharp margins, while those of atopic dermatitis are indistinct. In addition, involvement of the facial creases, crural folds, and diaper area favors seborrhea.

Scabies

Infantile or childhood atopic dermatitis with widespread papular morphology and excoriations is very similar in appearance to the papules and vesicular lesions of advanced scabies. In addition, the two diseases may coexist. It is fairly common for an atopic patient to acutely deteriorate during a concomitant scabies and/or bacterial infection. The practitioner must maintain a high index of suspicion. Family and contact history are helpful, and a scraping for ectoparasites should be obtained from several sites if there is any question.

Nonbullous Impetigo

Widespread nonbullous impetigo with excoriations can enter into this differential diagnosis. Crusting is more extensive and the lesions are usually more circumscribed with a minor degree of erythema.

Nummular Eczema

Lesions of nummular or discoid eczema are usually more discrete, coin-shaped, and have a moist exudative surface. Intervening skin areas are usually normal and the general dryness and other supporting signs of atopy are absent.

Lichen Simplex Chronicus (LSC)

This condition is also known as localized neurodermatitis, and because of the striking clinical similarity to atopic dermatitis, a linkage was postulated. Lesions of LSC are marked by intense pruritus and prominent lichenification. Unlike lesions of atopic dermatitis, they tend to be solitary or symmetrical. In addition, there are specific sites of predilection, which include the nuchal area, mid-shins, ankles, scalp, vulva, and posterior scrotum. A relationship to family or job-related stress is common.

Contact Dermatitis

Delayed contact dermatitis enters into the differential diagnosis of atopic dermatitis, and the two may coexist. An airborne contact allergy can simulate photosensitive atopic dermatitis. Shoe material allergy can simulate atopic dermatitis localized to that site. Both allergic and irritant contact reactions can simulate adult atopic hand dermatitis. Differentiation requires a high index of suspicion, careful history taking, and delayed patch testing when appropriate.

Tinea Corporis

Again the two diseases may coexist. With concomitant tinea, the course of the eczema usually deteriorates. In addition, the fungal infection is driven by the application of topical steroids. Unexplained deterioration of an atopic patient, especially with annular lesions or focal follicular pustules, should raise this question. KOH exam should be done from several sites.

Cutaneous T-Cell Lymphoma

This condition, also known as mycosis fungoides, can be very difficult to distinguish in its early stages from adult-onset atopic dermatitis. Unfortunately, even biopsy at times is not helpful. Nevertheless, any atypical features such as induration, areas of poikilo-

derma, sharp margins with islands of spared normal skin, or persistent adenopathy should prompt a skin biopsy.

Other Conditions

The following diseases are associated with a skin eruption that resembles atopic

Other Conditions

The following diseases are associated with a skin eruption that resembles atopic

dermatitis:

1.

Sex-linked agammaglobulinemia.

2.

Selective IgA deficiency.

3.

Anhidrotic ectodermal dysplasia.

4.

Ataxia telangectasia.

5.

Celiac disease.

รณ.

Heterozygous cystic fibrosis.

7.

Hurler's syndrome.

8.

Jung's disease.

9.

Nephrotic syndrome.

10.

Netherton's syndrome.

11.

Phenylkeytonuria.

12.

Wiskott-Aldrich syndrome.

13.

HTLV type-1 associated infective dermatitis.

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