Eczema is typically diagnosed clinically by correlating the patient’s history, symptoms, and physical findings together with other causes of atopic dermatitis that you may have seen. In scenarios where the diagnosis is unclear or where patients aren’t getting better and not responding to treatment, a biopsy can be performed to confirm the diagnosis. This may also be helpful in obtaining insurance reimbursement for certain hard to get treatments. However, it is becoming more unnecessary to do for insurance purposes. Clinical guidelines to diagnose atopic dermatitis include the presence of major features such as itching and pruritis, eczematous skin lesions, and distribution patterns according to age, chronic relapsing courses of disease, early age of onset and personal or family history of [?] Supporting features include atopic stigmata such as cirrhosis or dry skin. To assess the severity of atopic dermatitis, the eczema area scoring index, as well as the score ad scoring of atopic dermatitis and POEM, patient oriented eczema measure, are used to classify eczema. Differential diagnosis of eczema includes chronic dermatitis, infections and infestations, malignancies, primary immunodeficiencies, auto immune disorders, genetic and metabolic disorders, drug eruptions, photo sensitive conditions, and keratosis pilaris.