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MOC-diagnosis-and-differentials

John Montgomery4 min read

Diagnosis & Differentials

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  • Differential Diagnosis of Toddler Eczema — Rashes that mimic toddler eczema (seborrhoeic, scabies, psoriasis, tinea, molluscum, nappy/contact) and red flags for immunodeficiency.
  • Hanifin-Rajka Criteria — 1980 AD diagnostic criteria: 3 of 4 major + 3 of 23 minor features; most used in trials but cumbersome in clinic and for toddlers.
  • UK Working Party Criteria — Simplified AD criteria (itch + ≥3 of 5) usable without lab tests; NICE CG57 adapts them for under-4s; flexural item can miss extensor AD.
  • EASI — Clinician-rated eczema severity score (0–72), HOME core signs tool; child multipliers 0–7 y; bands differ (Leshem 7/21 vs Chopra 6/23).
  • SCORAD — Clinician-led eczema severity index (0–103) mixing extent, 6 signs and parent-rated itch/sleep; bands ~<29 mild, 29–49 moderate, ≥49 severe.
  • POEM — 7-question parent/patient-reported weekly eczema score (0–28); HOME core symptoms instrument; NICE-recommended; best home-tracking tool.
  • HOME Initiative — International group setting the core outcome set for eczema trials: EASI (signs), POEM (symptoms), IDQoL/CDLQI (QoL), RECAP/ADCT (control).
  • Seborrhoeic Dermatitis — Infant cradle cap/greasy fold rash; little itch, hits nappy and armpits (AD spares them); ~1 in 3 later develop AD.
  • Psoriasis — Sharply edged scaly plaques; in infants/toddlers often nappy area, scalp, behind ears; ~5% of children have AD–psoriasis overlap.
  • Scabies — Mite infestation; under-2s: palms, soles, face, scalp, armpit nodules; often mistaken for eczema; permethrin from 2 mo, whole household.
  • Permethrin — First-line scabies cream; UK/FDA licensed from 2 months, under-2s only under medical supervision; 1–5s up to ¼ tube; treat whole household.
  • Nappy Rash — Nappy-area rash: mostly irritant (spares folds); candida = beefy folds + satellite spots; AD usually spares it. Barrier cream first.
  • Barrier Creams — Protective ointments (petrolatum, zinc oxide, dimeticone) applied thinly to nappy and drool areas to shield skin from urine, faeces, saliva.
  • Drool Dermatitis — Irritant rash around the mouth and chin from saliva; common in teething babies and toddlers and can flare facial eczema
  • Lip-Licker’s Dermatitis — Saliva irritant dermatitis from lip-licking: red scaly ring matching tongue reach, crosses lip border; worse in winter.
  • Perioral Dermatitis — Rosacea-like papules around a child’s mouth, nose or eyes, often triggered by facial steroids; stop the steroid, use topical antibiotics.
  • Molluscum Dermatitis — Eczema patches around molluscum spots; commoner and longer-lasting with AD; red inflamed spots (BOTE sign) usually mean clearing.
  • Pityriasis Alba — Low-itch pale, finely scaly facial patches in children; a mild eczema linked to atopic dermatitis; clears over months to years.
  • Keratosis Pilaris — Harmless rough ‘chicken skin’ bumps on outer arms, thighs, cheeks; linked to atopic dermatitis and filaggrin; worse in winter.
  • Ichthyosis Vulgaris — Inherited dry, fish-scale skin from filaggrin (FLG) loss; appears in infancy, often coexists with eczema, predicts earlier, persistent AD.
  • Eczema in Skin of Colour — On brown/black toddler skin eczema looks violaceous, grey or dark, often papular/follicular/extensor; redness-based scores under-rate it.
  • Erythroderma — Red, inflamed skin over >90% of the body; a red flag in toddlers needing same-day/emergency care, often hospital; eczema is a leading cause.
  • When to Refer — When toddler eczema needs referral: same-day (herpeticum), urgent (2 weeks), routine dermatology, allergy, growth and psychology criteria.

Key Relations

Differential Diagnosis of Toddler Eczema [precedes] When to Refer Pityriasis Alba [part-of] Hanifin-Rajka Criteria Keratosis Pilaris [relates] Hanifin-Rajka Criteria UK Working Party Criteria [part-of] Hanifin-Rajka Criteria Eczema in Skin of Colour [contradicts] UK Working Party Criteria EASI [relates] SCORAD HOME Initiative [supports] EASI POEM [relates] EASI SCORAD [relates] HOME Initiative Seborrhoeic Dermatitis [part-of] Differential Diagnosis of Toddler Eczema Psoriasis [part-of] Differential Diagnosis of Toddler Eczema Scabies [part-of] Differential Diagnosis of Toddler Eczema Permethrin [treats] Scabies Nappy Rash [part-of] Differential Diagnosis of Toddler Eczema Barrier Creams [prevents] Nappy Rash Drool Dermatitis [relates] Perioral Dermatitis Lip-Licker’s Dermatitis [part-of] Differential Diagnosis of Toddler Eczema Perioral Dermatitis [contradicts] Lip-Licker’s Dermatitis Molluscum Dermatitis [part-of] Differential Diagnosis of Toddler Eczema Ichthyosis Vulgaris [relates] Keratosis Pilaris Erythroderma [precedes] When to Refer Pityriasis Alba [relates] Eczema in Skin of Colour Keratosis Pilaris [relates] Ichthyosis Vulgaris UK Working Party Criteria [relates] Differential Diagnosis of Toddler Eczema Eczema in Skin of Colour [relates] EASI EASI [relates] POEM HOME Initiative [regulates] SCORAD POEM [part-of] HOME Initiative Seborrhoeic Dermatitis [relates] Eczema in Skin of Colour Psoriasis [relates] Nappy Rash

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