Adult Atopic Dermatitis: Less Certainty, More Challenges

Abstract

We read with great interest the recent article by Silvestre Salvador et al [1] concerning the clinical and diagnostic challenges posed by adult atopic dermatitis (AD). We completely agree with the authors that the numerous problems faced by dermatologists and allergologists during the complex diagnostic and treatment process remain unresolved. Indeed, we previously underlined the need for specific and validated diagnostic criteria for adult AD in order to improve diagnostic accuracy and to gain more detailed and adequate epidemiologic data. Currently, the prevalence of adult AD is very variable (0.3%-14.3%) [2] owing to the lack of multicenter studies and of a common and validated diagnostic algorithm. Indeed, traditional diagnostic criteria for AD (Hanifin and Rajka, UK criteria) were developed specifically for children and were therefore not completely adaptable to adult patients, thus leading to reduced specificity and sensitivity [1,3,4]. Hence, there is still no clear consensus on the diagnostic work-up that should be performed when evaluating adult patients with AD, especially adult-onset AD, which is often diagnosed by exclusion. Although new treatments will appear in the near future, no standardized international guidelines for treatment of adult AD have been drafted, with the result that therapy varies widely from country to country [5]. We recently performed a thorough review of the literature on systemic drugs for treatment of adult AD and found limited evidence on effectiveness and long-term safety [5]. Moreover, we strongly believe that new investigations should focus on differences between persistent and adult-onset AD and seek approaches that facilitate diagnosis and treatment. In a recent preliminary analysis of 253 Italian adult AD patients [6], of whom 151 (59.7%) were affected with persistent disease and 102 (40.3%) had adult-onset AD, we found no significant differences between the 2 groups with regard to family history of AD, skin lesion morphology (an erythematous-desquamative pattern was the most frequent in both groups), and location of skin lesions (the flexures of the upper limbs were the most commonly involved areas, followed by the eyelid/periocular area, hands, and neck). Severe forms tended to be more common in persistent AD than in adult-onset AD (18.5% vs 7.8%, P<.05). No differences were found for comorbidities (cutaneous or systemic), except for hypertension, which was more frequent in adult-onset AD (13.7% vs 2.6%, P<.05). In conclusion, we agree with Silvestre Salvador et al that adult AD, particularly adult-onset AD, is an unexplored disease in which several issues remain unresolved (detailed incidence and prevalence data, diagnostic criteria, clinical forms, and differences in persistent vs adult-onset disease). These issues can only be addressed in multicenter studies and by increasing awareness of AD among the scientific community. FundingThe authors declare that no funding was received for the present study.

Reply to “Adult Atopic Dermatitis: Less Certainty, More Challenges”

“…We found the preliminary results reported by Megna et al [1] to be very interesting. The authors found that onset of atopic dermatitis was during adulthood in 40.3% of patients.…”

Optimizing a clinical guidance for diagnosis of atopic dermatitis in adults: joint recommendations of the Italian Society of Dermatology and Venereology (SIDeMaST), Italian Association of Hospital Dermatologists (ADOI), and Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA)

“…Considering this scenario, better definition of diagnostic criteria for adult onset ad is needed in order to avoid both misdiagnosis and/or undertreatment in adult patients. [25][26][27][28] In fact, despite significant advances in our understanding of the etiology and pathogenic mechanisms underlying AD, at present no markers are available that can help clinicians in routinely reaching a definitive diagnosis of ad. 1 to address these issues and provide practical guidance for clinicians to reliably diagnose ad in adult patients, representatives from three Italian dermatology scientific societies [Italian Society of Dermatology and Venereology (SidemaSt), italian association of Hospital dermatologists (adoi), italian Society of allergological, occupational and Environmental Dermatology (SIDAPA)] carried out a joint consensus meeting.…”

Involvement of stress in relapse of atopic dermatitis in adults

“…Больные атопическим дерматитом (АД) составляют более 3% (а по некоторым данным -до 40%) взрослого населения развитых стран [1,2], при этом наблюдается постоянный рост заболеваемости и утяжеление форм течения АД. Среди аллергических заболеваний на долю АД приходится 50-60% [3].…”