A diagnostic checklist for generalized dermatitis

Figures & data

Table 1 Final checklist informed by study results

Check	Diagnosis/action to consider	Comment/information if action is indicated
	Framing communication	There is no treatment for the itch of dermatitis that does not have potentially serious side effects when used over the long term. It may take many weeks to complete all of the work-up
	Patch test for allergic contact dermatitis	Patch test to include the personal and occupational contactants that are known sensitizers, which are currently in the patients’ environment; photo-patch testing may be needed to properly evaluate some sunscreens, plants, and fragrances
	Complete blood count with differential for hypereosinophilia	Perform test when the patient is off systemic corticosteroids; other useful studies: vitamin B12 and tryptase (in combination); flow cytometry, cytogenetics, and fluorescent in-situ hybridization studies if needed
	Tests for (non)bullous pemphigoid	Nonbullous (urticarial-phase) pemphigoid often requires direct immunofluorescence, indirect immunofluorescence, and bullous pemphigoid antigens by ELISA for diagnosis
	Microscopic examination of scraping for scabies	Mineral oil preparation for patients with facial sparing
	Inquire about the use of exposure to hot tub (contact allergy to “shock” treatment chemicals)	In patients with facial sparing^Citation7
	Inquire about exposure to sources of mites	Discrete very pruritic lesions present, ask about pets (cheyletiella), contact with birds, farming, cheese making, and oak trees^Citation8
	Examine for signs of (often amyopathic) dermatomyositis	Consider myositis panel
	Eczematous drug eruption	Review medications for temporal association, discontinue prescription and over-the-counter medicines if potential association with drug rash, and evaluate for improvement. Patch testing may be performed for eczematous and fixed drug reaction
	Inquire about exposure to hydroxyethyl starch as a volume expander,^Citation9 recreational drugs, or history of biliary tract obstruction	Rash appears to be secondary to scratching and no primary lesions on examination
	Additional biopsies rule out cutaneous T cell lymphoma	Accentuation of dermatitis in photoprotected skin
	Test for dermatographism	Rash is accentuated by tight contact with garments or pressure
	Trial of gabapentin (rule out multilevel symmetric neuropathic pruritus)	Dermatitis is fixed in distribution, in patients with risk factors for degenerative disk disease^Citation10
	Empiric treatment with systemic azole, followed by gentle acidification with cleansers and a topical azole body wash maintenance for the treatment of seborrheic dermatitis component	Postpubertal patients with head and upper torso predominance
	Bacterial culture of skin to select antistaphylococcal antibiotics	Patients with the history of childhood onset “eczema”; necessary to follow bleach bath with rinsing; and low pH products to counteract irritancy
	Bone marrow biopsy	Patients with suspected myelofibrosis
	Assess for lower extremity edema provoking auto eczematization	Patients with stasis dermatitis; discontinue amlodipine if a current medication; compression in conjunction with calf-pumping exercises
	Obtain history of travel to Southwest US	Coccidiomycosis, generalized hypersensitivity type can rarely present as dermatitis
	Inquire about implanted device	Temporal association and anatomical accentuation
	Consider paraneoplastic syndrome	For example, Bazex if acral accentuation

Note: Italicized verbiage was added during the initial usage interval of this study.

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