Practical Management of Atopic Dermatitis: Nurse Practitioner and Physician Assistant Perspectives - Episode 11

Techniques Used to Diagnose Atopic Dermatitis

August 30, 2021
Melodie Young, MSN, RN, ANP-C, Mindful Dermatology and Modern Research Associates

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Douglas DiRuggiero, DMSc, PA-C, Skin Cancer and Cosmetic Dermatology Center

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Keri Holyoak, PA-C, MPH, Dermatology Center of Salt Lake

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Susan Tofte, DNP, MS, FNP-C, Oregon Health & Science University

Strategies used to evaluate patients and accurately diagnose atopic dermatitis in children and adults.

Melodie Young, MSN, RN, ANP-C: When talking about making decisions, there’s nothing discussing the role of biopsy in dermatology or trying to get a pathologic evaluation. Would either of you speak to whether you do that or need to do it? You mentioned it and ruling out other things in the adult population, but do you put children through biopsies?

Susan Tofte, DNP, MS, FNP-C: No. It’s a clinical diagnosis.

Douglas DiRuggiero, DMSc, PA-C: It’s very rare.

Keri Holyoak, PA-C, MPH: That’s the hard thing about this is: there’s not the gold standard blood test. The diagnosis is generally clinical. At times, it can be challenging, and biopsies won’t help with that.

Douglas DiRuggiero, DMSc, PA-C: Susan mentioned that she was with Dr [Jon] Hanifin for so long. With the Hanifin–Rajka [Georg Rajka] criteria, some of those things have been updated—you’ve got to have 3 of 4 major criteria and 3 of 23 minor criteria to get the diagnosis. In 2014, Hanifin-Rajka led the charge for those AD [atopic dermatitis] recommendations. By looking at essential features vs important features vs associated features, we have 3 categories. There’s some literature out there from overseas and the London or the England workers group criteria for diagnosing atopic dermatitis. We have 2 or 3 ways of looking at them, but the overlap is the things we’ve already mentioned. It’s looking at chronicity, relapsing, intermittent, supporting diagnostic features, distribution, periorbital, the neckline, and the palms. With all those things, it’s extraordinarily rare—in my hands, maybe less than 5 times that I’ve actually biopsied someone under the age of 15, to tell me that it’s atopic dermatitis.

Melodie Young, MSN, RN, ANP-C: They can’t even give you a definitive. They’ll just say it’s consistent with or supporting of, so you’re not going to ever get a diagnosis. Yes, this looks like it because it’s just that spongiotic dermatitis. One of the things we definitely know exists in patients with atopic dermatitis is asthma, or seasonal allergies. I’ll often say that some people who have this will sneeze, some will wheeze, and some are rash, and some will do all the above. How much thought or history do you take with what the patient experiences with and things that run in the family? Do you think that plays a difference if there was a diagnosis of asthma in the siblings or in the parents, and now your patient has what you think is AD? Is that a major player for you?

Susan Tofte, DNP, MS, FNP-C: It’s a player. Family history is really important. This is a disease that tends to be genetic; it runs in families. I always ask, “Does anybody in your family have eczema or asthma or hay fever or allergies?” Usually, there’s 1 other family member, and very often it’s a parent of the child or it will be a close family member who has 1 or more of these disease components. 

Melodie Young, MSN, RN, ANP-C: Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your in-box.

Transcript Edited for Clarity

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