{"id":639,"date":"2026-08-19T16:58:31","date_gmt":"2026-08-19T08:58:31","guid":{"rendered":"https:\/\/eczema.skinmedical.com.hk\/diagnosis\/"},"modified":"2026-08-19T17:39:26","modified_gmt":"2026-08-19T09:39:26","slug":"diagnosis","status":"publish","type":"page","link":"https:\/\/eczema.skinmedical.com.hk\/en\/diagnosis\/","title":{"rendered":"How atopic dermatitis is diagnosed"},"content":{"rendered":"<div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-c274ed7d\" data-vce-do-apply=\"all el-c274ed7d\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-66-66p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-56a3fc3d\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-56a3fc3d\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-56a3fc3d\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-121a7c8f\" data-vce-do-apply=\"all el-121a7c8f\"><h2><span style=\"color: #808080;\">Eczema&nbsp;<\/span><\/h2>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-3c5d7ed9\" data-vce-do-apply=\"all el-3c5d7ed9\"><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-14218ddf\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-14218ddf\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-14218ddf\"><div class=\"vce vce-separator-container vce-separator--align-center vce-separator--style-solid\" id=\"el-6f0e311a\" data-vce-do-apply=\"margin el-6f0e311a\"><div class=\"vce-separator vce-separator--color-bfc0c1 vce-separator--width-100 vce-separator--thickness-1\" data-vce-do-apply=\"border padding background  el-6f0e311a\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-684633cb\" data-vce-do-apply=\"all el-684633cb\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-22-12p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-3dc32602\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-3dc32602\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-3dc32602\"><div class=\"vce-single-image-container vce-single-image--align-center\"><div class=\"vce vce-single-image-wrapper\" id=\"el-694c7819\" data-vce-do-apply=\"all el-694c7819\"><figure><div class=\"vce-single-image-figure-inner\" style=\"width: 400px;\"><div class=\"vce-single-image-inner vce-single-image--absolute\" style=\"width: 100%; padding-bottom: 66.75%;\"><img loading=\"lazy\" decoding=\"async\" class=\"vce-single-image\"  width=\"400\" height=\"267\" srcset=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2024\/05\/photo-1586282091736-c2f9a8af8772-320x214.jpg 320w, https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/photo-1586282091736-c2f9a8af8772-400x267.jpg 400w\" src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2026\/08\/photo-1586282091736-c2f9a8af8772-400x267.jpg\" data-img-src=\"https:\/\/eczema.skinmedical.com.hk\/wp-content\/uploads\/2024\/05\/photo-1586282091736-c2f9a8af8772.jpg\" data-attachment-id=\"312\"  alt=\"\" title=\"\" \/><\/div><\/div><figcaption hidden=\"\"><\/figcaption><\/figure><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-77-86p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last\" id=\"el-76605d76\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-76605d76\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-76605d76\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-09ed9f83\" data-vce-do-apply=\"all el-09ed9f83\"><h3><strong><span style=\"color: #756464;\"><span style=\"color: #756464;\">How atopic dermatitis is diagnosed<\/span><\/span><\/strong><\/h3>\r\n<p>&nbsp;<\/p>\r\n<p><span style=\"color: #756464;\"><span style=\"font-size: 15pt;\">There is no blood test that diagnoses atopic dermatitis. It is a clinical diagnosis, made on history and examination against established criteria (Hanifin and Rajka; the UK Working Party criteria).<br>\r\nA thorough assessment would typically involve:<br>\r\n<\/span><\/span><\/p>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-97a192a2\" data-vce-do-apply=\"all el-97a192a2\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-2de7b88f\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-2de7b88f\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-2de7b88f\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-a1ba932d\" data-vce-do-apply=\"all el-a1ba932d\"><p>&nbsp;<\/p>\r\n<ul>\r\n \t<span style=\"color: #756464;\">\r\n<li><span style=\"color: #756464;\"><strong>History<\/strong> \u2014 age at onset, pattern over time, itch severity, sleep disruption, personal and family history of atopy, occupational and hobby exposures, all previous treatments and how they were actually used.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Full skin examination<\/strong>, including scalp, hands, feet and flexures.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Severity scoring<\/strong> \u2014 EASI or SCORAD, plus POEM and DLQI for patient-reported impact. Recorded at baseline so change can be measured objectively.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Photography<\/strong> for comparison over time.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Assessment for infection<\/strong> where indicated, with swabs.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Allergy testing<\/strong> \u2014 selectively, not routinely. Specific IgE or skin prick testing is appropriate where the history suggests an immediate reaction to a specific food, or where a child has moderate-to-severe eczema not responding to good treatment. Testing without a suggestive history produces false positives that lead to unnecessary food avoidance, which is harmful \u2014 it does not improve eczema and can precipitate genuine food allergy.<\/span><\/li>\r\n<li><span style=\"color: #756464;\"><strong>Patch testing<\/strong> where allergic contact dermatitis is suspected \u2014 particularly in adults with hand eczema, eyelid involvement, or eczema that has changed pattern or stopped responding.<\/span><\/li>\r\n<\/span><\/ul>\r\n<p>&nbsp;<\/p>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-10 vce-row-equal-height vce-row-content--top\" id=\"el-aa567192\" data-vce-do-apply=\"all el-aa567192\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-76d16138\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-76d16138\" vce-box-shadow=\"el-76d16138\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-76d16138\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-0774a5c1\" data-vce-do-apply=\"all el-0774a5c1\"><h3><span style=\"color: #756464;\">Differential diagnosis<\/span><\/h3>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-7b4af443\" data-vce-do-apply=\"all el-7b4af443\"><div align=\"left\">\r\n<table style=\"border-collapse: collapse; width: 93%; margin-right: calc(7%); border: medium none currentcolor;\">\r\n<tbody>\r\n<tr>\r\n<td style=\"color: #efefef; background-color: #efefef; border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><strong><span style=\"font-family: 'Google Sans', sans-serif;\">Condition<\/span><\/strong><\/span><\/td>\r\n<td style=\"color: #efefef; background-color: #efefef; border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><strong><span style=\"font-family: 'Google Sans', sans-serif;\">Distinguishing features<\/span><\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Seborrhoeic dermatitis<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Greasy yellowish scale; scalp, eyebrows, nasolabial folds; less itchy<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Psoriasis<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Sharply demarcated, thick silvery scale; extensor surfaces, scalp, nails<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Scabies<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px; font-family: 'Google Sans', sans-serif;\">Burrows, finger webs, wrists, genitals; itch worse at night; other household members itching<\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Tinea (fungal)<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Ring-shaped with an active scaly edge and central clearing; positive microscopy<\/span><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Contact dermatitis<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Corresponds to a contact site; adult onset; patch test positive<\/span><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Cutaneous T-cell lymphoma<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Adult onset, persistent fixed patches, unresponsive to treatment; biopsy required<\/span><\/span><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 24.1134%;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Immunodeficiency<\/span><\/span><\/td>\r\n<td style=\"border: 0.75pt solid #c4c7c5; width: 75.7613%; text-align: center;\"><span style=\"color: #756464; font-size: 16px;\"><span style=\"font-family: 'Google Sans', sans-serif;\">Severe infantile eczema with recurrent serious infections and failure to thrive<\/span><\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div><\/div><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-09f69842\" data-vce-do-apply=\"all el-09f69842\"><p><span style=\"color: #756464;\">The most common mistakes in practice: scabies mistaken for a flare and treated with steroids, tinea treated with steroids, and adult-onset \"eczema\" that is actually cutaneous lymphoma. Any eczema that is unusual in pattern, adult in onset, or genuinely unresponsive to correct treatment warrants a fresh look.<\/span><\/p>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-be6816a0\" data-vce-do-apply=\"all el-be6816a0\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-561ed39f\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-561ed39f\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-561ed39f\"><div class=\"vce-text-block\"><div class=\"vce-text-block-wrapper vce\" id=\"el-ad3471b3\" data-vce-do-apply=\"all el-ad3471b3\"><p><span style=\"color: #756464; font-size: 12pt;\">Reference:<\/span><\/p>\r\n<ol>\r\n \t<span style=\"color: #756464; font-size: 12pt;\">\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Davis DMR, Drucker AM, Alikhan A, et al. AAD guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Sidbury R, Alikhan A, Bercovitch L, et al. AAD guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2023.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Guidelines Development Panel of the Hong Kong College of Paediatricians. Management of Atopic Dermatitis in Children: 2020 Review. HK J Paediatr. 2021;26:42-57. \u2014 the key local reference; cite this prominently.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Wollenberg A, Kinberger M, Arents B, et al. EuroGuiDerm guideline on atopic eczema. J Eur Acad Dermatol Venereol. (most recent update).<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. CG57.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Leung R, Wong G, Lau J, et al. Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 1997.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong: ISAAC Study from 1995 to 2015. \u2014 source of the 21-year local trend data.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Efficacy and Safety of Lebrikizumab in Combination With Topical Corticosteroids in Adolescents and Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial (ADhere). JAMA Dermatol.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">ARCADIA 1 and ARCADIA 2 \u2014 two identically designed pivotal phase III trials enrolling more than 1,700 patients, evaluating nemolizumab administered subcutaneously every four weeks versus placebo with background topical corticosteroids.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Sanofi. Press release: decision not to submit amlitelimab in atopic dermatitis for global regulatory reviews. Paris, 24 July 2026.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Simpson EL, Bieber T, Guttman-Yassky E, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis (SOLO 1 and SOLO 2). N Engl J Med. 2016.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Chalmers JR, et al. BEEP trial: daily emollient during the first year of life for preventing atopic dermatitis. Lancet. 2020. \u2014 the negative prevention trial cited in the article.<\/span><\/li>\r\n<li><span style=\"color: #756464; font-size: 12pt;\">Hong Kong Drug Office, Department of Health \u2014 verify local registration status of every systemic agent named.<\/span><\/li>\r\n<\/span><\/ol>\r\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Eczema&nbsp; How atopic dermatitis is diagnosed &nbsp; There is no blood test that diagnoses atopic dermatitis. It is a clinical diagnosis, made on history and examination against established criteria (Hanifin and Rajka; the UK Working Party criteria). A thorough assessment would typically involve: &nbsp; History \u2014 age at onset, pattern over time, itch severity, sleep&hellip; <a class=\"more-link\" href=\"https:\/\/eczema.skinmedical.com.hk\/en\/diagnosis\/\">Continue reading <span class=\"screen-reader-text\">How atopic dermatitis is diagnosed<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-639","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>How atopic dermatitis is diagnosed<\/title>\n<meta name=\"description\" content=\"A thorough assessment would typically involve: History, Full skin examination, Severity scoring, Photography, Assessment for infection etc\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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