AD typically begins early in life, most commonly with skin lesions developing within the first 6 mo. Although this pattern is typical, alterations in presentation frequently occur. A careful history can therefore be useful in making the diagnosis of AD. As noted previously, a family history of atopic disease may provide a clue to the etiology of a patient's skin disease. As many as 80% of patients with AD have a positive family history of atopy. A comprehensive history with regard to possible exacerbating triggers can also be helpful. These triggers may include foods, seasonal allergens, environmental conditions, irritants, emotional distress, and occupational exposures. A careful history will often uncover an exacerbating factor that is unapparent to the patient or the physician. The most prominent and persistent feature detected by historical evaluation is intense pruritus associated with a chronically relapsing course of skin disease.
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