Differential Diagnosis of Atopic Dermatitis

  • Ichiro KatayamaEmail author


Regarding the treatment of atopic dermatitis (hereafter referred to “AD”), diagnostic criteria proposed by the Japanese Dermatological Association [1] and therapeutic guidelines established by the Japanese Society of Allergology [2] have been published. These guidelines enable us to conduct standard therapy for mild to severe pediatric and adult AD. Therapeutic methodology based on EBM will likely be established in the twenty-first century. Using these criteria, all diseases that meet the three requirements of itching, characteristic rashes and distribution, and chronic/recurrent progression will be diagnosed as atopic dermatitis irrespective of the severity of symptoms [1]. From this point of view, in this chapter, we summarize the differential diagnosis of AD (Table 19.1), which is required for assessing daily treatment. Important differential diagnoses listed in diagnostic criteria proposed by the Japanese Dermatological Association are as follows: contact dermatitis, seborrheic dermatitis, prurigo simplex, scabies, miliaria, ichthyosis, xerotic eczema, hand dermatitis (nonatopic), cutaneous lymphoma, psoriasis, immune deficiency diseases, collagen diseases (systemic lupus erythematosus and dermatomyositis), and Netherton syndrome. However, skin diseases or manifestations which should be differentiated from AD are different among infantile, childhood, and adult atopic dermatitis (Table 19.1). Misdiagnosis occasionally results in unfavorable prognosis, especially for cutaneous lymphoma, dermatomyositis, or infectious diseases. Therefore, careful observation and evaluation of skin manifestations is required to make a correct diagnosis of AD.


Atopic Dermatitis Differential Diagnosis Vitiligo Cedar Pollen Dermatitis IgE 


  1. 1.
    Saeki H, Furue M, Furukawa F et al.; Committee for Guidelines for the Management of Atopic Dermatitis of Japanese Dermatological Association. Guidelines for management of atopic dermatitis. J Dermatol 2009;36:563–577.Google Scholar
  2. 2.
    Katayama I, Kohno Y, Akiyama K, et al. Japanese Guideline for Atopic Dermatitis 2014. Japanese Society of Allergology. Allergol Int. 2014;63:377–98.CrossRefGoogle Scholar
  3. 3.
    Takahashi A, Tani S, Murota H, Katayama I. Histamine modulates sweating and affects clinical manifestations of atopic dermatitis. Curr Probl Dermatol. 2016;51:50–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Uehara M, Hayashi S. Hyperlinear palms: association with ichthyosis and atopic dermatitis. Arch Dermatol. 1981;117:490–1.CrossRefPubMedGoogle Scholar
  5. 5.
    Imokawa G, Abe A, Jin K, et al. Decreased level of ceramides in stratum corneum of atopic dermatitis: an etiologic factor in atopic dry skin? J Invest Dermatol. 1991;96:523–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Sugiura A, Nomura T, Mizuno A, et al. Reevaluation of the non-lesional dry skin in atopic dermatitis by acute barrier disruption: an abnormal permeability barrier homeostasis with defective processing to generate ceramide. Arch Dermatol Res. 2014;306:427–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Kao JS, Fluhr JW, Man MQ, et al. Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities. J Invest Dermatol. 2003;120:456–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Danby SG, Chittock J, Brown KA, et al. The effect of tacrolimus compared with betamethasone valerate on the skin barrier in volunteers with quiescent atopic dermatitis. Br J Dermatol. 2014;170:914–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Arase N, Wataya-Kaneda M, Oiso N, et al. CD1a-positive familial cutaneous mastocytosis without germ-line or somatic mutations in c-kit. Br J Dermatol. 2013;169:201–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Ishida T, Ohashi M, Matsumoto Y, et al. Connection of atopic disease in Japanese patients with juvenile dermatomyositis based on serum IgE levels. Clin Rheumatol. 1993;12:41–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Okiyama N, Kohsaka H, Ueda N, et al. Seborrheic area erythema as a common skin manifestation in Japanese patients with dermatomyositis. Dermatology. 2008;217:374–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Briot A, Deraison C, Lacroix MB, et al. Kallikrein 5 induces atopic dermatitis-like lesions through PAR2-mediated thymic stromal lymphopoietin expression in Netherton syndrome. J Exp Med. 2009;206:1135–47.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hagl B, Heinz V, Schlesinger A, et al. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children. Pediatr Allergy Immunol. 2016;27:177–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Wei J, Zhang Y, Xu H, Jin J, Zhang J. Atopic dermatitis-like presentation of graft-versus-host disease: a novel form of chronic cutaneous graft-versus-host disease. J Am Acad Dermatol. 2013;69:34–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Yokozeki H, Takayama K, Katayama I, Nishioka K. Japanese cedar pollen as an exacerbation factor in atopic dermatitis: results of atopy patch testing and histological examination. Acta Derm Venereol. 2006;86:148–51.PubMedGoogle Scholar
  16. 16.
    Murakami Y, Matsui S, Kijima A, et al. Cedar pollen aggravates atopic dermatitis in childhood monozygotic twin patients with allergic rhino conjunctivitis. Allergol Int. 2011;60:397–400.CrossRefPubMedGoogle Scholar
  17. 17.
    Tuzova M, Richmond J, Wolpowitz D, et al. CCR4+T cell recruitment to the skin in mycosis fungoides: potential contributions by thymic stromal lymphopoietin and interleukin-16. Leuk Lymphoma. 2015;56:440–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Hanafusa T, Matsui S, Murota H, et al. Increased frequency of skin-infiltrating FoxP3+ regulatory T cells as a diagnostic indicator of severe atopic dermatitis from cutaneous T cell lymphoma. Clin Exp Immunol. 2013;172:507–12.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Wollenberg A. Eczema herpeticum. Chem Immunol Allergy. 2012;96:89–95.CrossRefPubMedGoogle Scholar
  20. 20.
    Wollenberg A, Seba A, Antal AS. Immunological and molecular targets of atopic dermatitis treatment. Br J Dermatol. 2014;170(Suppl 1):7–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Mohan GC, Silverberg JI. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2015;151:522–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Tanemura A, Yajima T, Nakano M, et al. Seven cases of vitiligo complicated by atopic dermatitis: suggestive new spectrum of autoimmune vitiligo. Eur J Dermatol. 2012;22:279–80.PubMedGoogle Scholar
  23. 23.
    Fregert S, Moller H, Rorsman H. Observations on vitiligo in a patient with atopic dermatitis. Acta Derm Venereol. 1959;39:225–9.PubMedGoogle Scholar
  24. 24.
    Jin Y, Mailoux CM, Gowan K, Riccardi SL, LaBerge G, Bennett DC, Fain PR, Sprits RA. NALP1 in vitiligo-associated multiple autoimmune disease. N Engl J Med. 2007;356:1216–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Kitaba S, Matsui S, Iimuro E, et al. Four cases of atopic dermatitis complicated by Sjögren’s syndrome: link between dry skin and autoimmune anhidrosis. Allergol Int. 2011;60:387–91.CrossRefPubMedGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Dermatology, Course of Integrated Medicine, Graduate School of MedicineOsaka UniversityOsakaJapan

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