TABLE 65.2 AMERICAN ACADEMY OF DERMATOLOGY CONSENSUS CONFERENCE FEATURES OF ATOPIC DERMATITIS Essential features (must be present) Pruritus Eczematous skin changes with chronic or recurring history, typical morphology, and distribution • Face, neck, extensor involvement in infants and children • Flexural lesions in any age group • Sparing of groin and axillary regions Important features (seen in most cases, support the diagnosis) Early age at diagnosis Personal or family history of atopy Immunoglobulin E reactivity Associated features Atypical vascular responses (e.g., facial pallor, white dermographism, delayed blanch response) Keratosis pilaris/hyperlinear palms/ichthyosis/pityriasis alba Ocular/periorbital changes Other regional findings (e.g., perioral changes/periauricular lesions) Perifollicular accentuation/lichenification/prurigo lesions Adapted from Eichenfield LF, Hanifin JM, Luger TA, et al Consensus conference on pediatric atopic dermatitis J Am Acad Dermatol 2003;49(6):1088–1095 Copyright © 2003 with permission from the American Academy of Dermatology Acute management of nummular eczema involves ruling out any coexistent superinfection with a bacterial culture from any eroded, crusted, pustular, or painful lesions, and treatment with potent topical steroids Maintenance strategies include using daily petrolatum-based barrier ointments and intermittent potent topical steroid use (e.g., twice weekly) for prevention