Atopic dermatitis, commonly known as eczema, is a chronic inflammatory skin condition marked by an impaired skin barrier and a heightened immune response. Describing this condition accurately on a physical exam allows medical professionals to communicate clearly and track disease progression. This standardized description details the specific appearance, location, and activity of the skin changes.
The Primary Appearance of Eczema
The initial assessment of eczema focuses on the morphology, or form, of the individual skin lesions. A key feature is erythema, which describes the redness caused by increased blood flow and inflammation in the affected skin areas. However, in people with darker skin tones, this inflammation may not appear red but rather as violaceous (purple or violet) or dark brown patches, making color description relative to the patient’s baseline skin tone.
The texture and elevation of the lesions are also carefully noted using specific dermatological terms. Small, solid, raised bumps less than 10 millimeters in diameter are called papules, which often cluster together. When these smaller lesions merge into larger, broad, flattened areas, they are described as plaques. In the most acute flare-ups, tiny fluid-filled blisters called vesicles may appear, sometimes leading to visible swelling known as edema.
The surface of these lesions may also present with scaling, indicating a buildup of dead skin cells due to accelerated turnover. In severe acute eczema, the vesicles can break open, resulting in a wet, sticky surface described as weeping or oozing, which often dries into a crust.
Mapping the Eczema Location
A significant part of the eczema physical exam involves documenting the topography and distribution of the lesions across the body. The location is often a distinguishing characteristic of atopic dermatitis, depending on the patient’s age. Lesions may be localized or generalized, covering large portions of the body.
A common pattern in older children and adults is involvement of the flexural surfaces, which are the skin creases where joints bend, such as the inner elbows (antecubital fossae) and behind the knees (popliteal fossae). Conversely, infants often exhibit lesions on the extensor surfaces (the outside of joints), the face, and the scalp. Understanding these age-specific patterns helps confirm the diagnosis.
The distribution may also be symmetric, appearing on both sides of the body, which is typical for atopic dermatitis. For example, a description might note bilaterally symmetric, erythematous plaques in the antecubital fossae. Specific locations, like sparing the diaper area in infants, support the clinical assessment.
Describing Activity and Secondary Features
The final layer of the physical exam description addresses the dynamic nature of eczema, focusing on its current activity and any secondary features. Activity is categorized as acute or chronic, reflecting the stage of the inflammatory process. Acute eczema is characterized by intense redness, oozing, crusting, and pronounced swelling.
In contrast, chronic eczema presents as a drier condition, defined by changes resulting from the long-term disease course and repetitive patient behavior. The most telling secondary feature is lichenification, which is the thickening and leathery appearance of the skin, with an exaggeration of normal skin lines. This change occurs due to persistent scratching and rubbing, a response to the intense itch, or pruritus.
Other secondary changes linked to scratching are excoriations, which are linear erosions or scabs marking where the patient has broken the skin. Deep, painful cracks in the skin, called fissures, may also be present, especially in areas of thickened, dry skin subject to movement. Overall severity is often noted using terms like mild, moderate, or severe.