Onset of atopic dermatitis in adolescence or later is uncommon and should prompt consideration of another diagnosis. Disease manifestations vary with age. The emergency physician often is the first to diagnose eczema. The most common presentation is that of an infant, usually less than 6 months, brought in by his or her parents for a persistent rash. Parents usually report the rash has waxed and waned for months and a history of dry skin since birth.
Predominant symptom is intense pruritus.
Atopic dermatitis typically is not associated with fever or other constitutional symptoms. Dermatologic manifestations of eczema usually occur on the cheeks, diaper area, hands, and extensor surfaces in children. The antecubital and popliteal fossae often are involved in adults. Older children and adults presenting to the ED usually know of their diagnosis but present because of a flare-up or complication. In adults with limited distribution of lesions, a history of childhood eczema aids in diagnosis.