Differentiating Pediatric Atopic Dermatitis, Psoriasis, and Seborrheic Dermatitis

In pediatric patients, distinguishing atopic dermatitis from psoriasis and seborrheic dermatitis is essential for appropriate management and escalation of care. Typical anatomic distributions can be highly informative. Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, notes that psoriasis in children more often involves the elbows, knees, and especially the scalp, frequently in the context of a recent streptococcal infection. In contrast, atopic dermatitis favors the antecubital and popliteal fossae and the face and tends to have less sharply demarcated borders. Seborrheic dermatitis in infants and young children often presents as “cradle cap” on the scalp with extension to intertriginous sites, such as the axillae and diaper area, locations that are less characteristic of atopic dermatitis.

Beyond morphology and distribution, chronicity and response to initial treatment provide important diagnostic cues. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, emphasizes that pediatricians should reassess the working diagnosis when a presumed eczematous eruption fails to respond as expected to appropriate topical corticosteroids and allergen reduction. Lack of improvement, unusual distribution, or atypical symptom evolution—particularly in the setting of significant comorbidities or recurrent infections—should prompt consideration of alternative diagnoses, including psoriasis, pustular disorders, or infectious mimics.

This discussion, featuring Hebert and Atkinson, is presented as part of a special report video series on updates in atopic dermatitis and psoriasis in pediatric patients. In this opening segment, the faculty frame the core clinical challenge for general pediatricians: recognizing patterns that differentiate common inflammatory dermatoses and identifying red flags that warrant dermatology consultation to optimize outcomes.