NICE says AD diagnosis should be based on the presence of itching and at least three of the following:15

·       a history of involvement of the skin creases/flexures

·       a personal history of asthma or hay fever (or atopic disease in a first degree relative of children under 4 years)

·       long-term dry skin

·       onset first occurred aged under 2 years (not applicable for children under 4)

·       visible flexural eczema (including eczema affecting cheeks, forehead or outer aspects of limbs in children under 4).

Note that in children of Asian, or black African or Caribbean ethnicity, AD €can affect the extensor surfaces rather than the flexures, and discoid or follicular patterns may be more common.€ Differential diagnoses include psoriasis, scabies, fungal or other infection, as well as other eczematous conditions such as allergic contact or seborrhoeic dermatitis.15

Children with AD often find their skin improves by puberty, and may clear completely, although adults may then have more sensitive skin than the general population. The more severe the eczema is in young childhood, the more likely AD will persist into adulthood.1