Diagnosis and Management of Infantile Eczema

Clinical Presentation and Diagnosis

In infancy, atopic dermatitis characteristically starts on the cheeks and extends to the neck, trunk, and extensor surfaces of extremities, as recommended by the American Academy of Pediatrics 1, 2
The patient's lesions on the face, scalp, trunk, and extensors are consistent with the expected distribution for their age group, according to the American Academy of Dermatology 1
The diaper area is typically spared in infantile eczema, which helps distinguish it from other conditions, as noted by the American Academy of Pediatrics 1
The "crusty, cracky, and weepy" description indicates acute eczematous lesions with secondary bacterial infection, as described in the British Medical Journal 3, 4
Acute lesions present as erythema, exudation, papules, and vesiculopapules, as characterized by the American Academy of Dermatology 1
Crusting and weeping specifically suggest bacterial superinfection, commonly with Staphylococcus aureus, as reported in the British Medical Journal 3, 4

The patient fulfills all three essential diagnostic criteria for atopic dermatitis: pruritus, eczematous lesions with age-specific distribution, and chronic or relapsing course, as defined by the American Academy of Dermatology 1, 2
The age-specific distribution pattern is characteristic of atopic dermatitis, not drug reactions, as distinguished by the American Academy of Pediatrics 1
The transition to "childhood pattern" (affecting flexor surfaces) typically occurs after age 2-4 years, as described by the American Academy of Pediatrics 1, 2
Scabies should be excluded in the differential diagnosis by looking for burrows in finger webs, as recommended by the British Medical Journal 5, 4
Immunodeficiency states should be excluded by checking for recurrent systemic infections and petechiae, as suggested by the British Medical Journal 5, 4