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Acute lupus erythematosis

Lupus is distinguished by its malar "butterfly" rash that spares the nasolabial folds and the presence of systemic symptoms, unlike the more generalized pruritus of eczema.

Airborne allergic contact dermatitis

This is distinguished by its distribution on exposed skin with sharp cutoffs at clothing lines and sparing of protected areas like under the chin.

Allergic contact dermatitis

This is identified by a distribution that perfectly matches the shape of an external allergen (e.g., a metal snap), a clue not seen in endogenous eczema.

Asteatotic eczema

This is a specific type of eczema characterized by a "crazy-paving" or cracked appearance on very dry skin, typically on the shins of older adults.

Autosensitization reaction

The key to this diagnosis is the history of a primary inflammatory focus (like a fungal infection) that precedes the widespread secondary eczematous rash.

Chronic actinic dermatitis

This is a severe, persistent photosensitive eczema in older men, distinguished by its strict confinement to sun-exposed areas.

Contact dermatitis

This is a broad category; its allergic form has sharp borders matching an allergen, while its irritant form is more related to pain/burning than the intense itch of atopic eczema.

Dermatitis herpetiformis

The key feature is grouped, intensely itchy vesicles on the elbows and knees, a presentation distinct from the scaly plaques of eczema.

Dermatomyositis

The pathognomonic violaceous rash on the eyelids (heliotrope) and papules on the knuckles (Gottron) are the key features that separate this from eczema.

Drug phototoxicity

This is a painful, exaggerated sunburn reaction, not a primarily pruritic, eczematous rash.

Eczema herpeticum

This is a complication of eczema, distinguished by the sudden eruption of monomorphic, "punched-out" erosions or vesicles on top of existing dermatitis, often with fever.

Erythrodermic mycosis fungoides

This T-cell lymphoma is suspected when total-body redness is recalcitrant to standard eczema therapy and may have "islands" of spared skin.

Irritant dermatitis

This is caused by direct chemical or physical damage and is often more painful than itchy, unlike the pruritus-defined nature of atopic eczema.

Juvenile plantar dermatosis

This is characterized by a shiny, glazed erythema on the weight-bearing surfaces of children's feet, sparing the arch, a specific pattern not seen in general eczema.

Lichen planus

The violaceous, flat-topped, polygonal papules of lichen planus are morphologically distinct from the ill-defined, scaly patches of eczema.

Lichen simplex chronicus

This is a localized, thickened, leathery plaque that is the result of chronic scratching, not a primary inflammatory dermatitis itself.

Paget's disease

A unilateral, non-healing eczematous plaque on the nipple is the classic presentation of this underlying breast cancer.

Pemphigus foliaceus

This autoimmune disease is characterized by superficial, fragile, crusted erosions that look like "cornflakes," a different primary lesion than in eczema.

Photoallergic drug reaction

This is an eczematous rash, but it is specifically triggered by a drug-sunlight interaction and confined to sun-exposed areas.

Polymorphic light eruption

This is a transient, itchy eruption of papules that appears only after sun exposure and resolves, unlike the chronic nature of atopic eczema.

Scabies

The diagnosis of this mite infestation is suggested by intense nocturnal itching, the presence of burrows (especially in finger webs), and involvement of other household members.

Seborrhoiec dermatitis

This is distinguished by its greasy, yellowish scale and predilection for oily areas like the scalp, eyebrows, and nasolabial folds.

Sezary syndrome

This leukemic lymphoma is distinguished from severe eczema by the presence of significant lymphadenopathy and circulating malignant T-cells in the blood.

Stasis dermatitis

This form of eczema is localized to the lower legs and is defined by the presence of underlying edema and other signs of venous insufficiency.

Tinea

This fungal infection is characterized by an annular plaque with a raised, scaly, advancing border and is confirmed by a positive KOH test.

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