Adult onset atopic dermatitis: Under-recognized or under-reported?

Kanwar, Amrinder J.; Narang, Tarun

doi:10.4103/2229-5178.115508

Cited by 27 publications

(28 citation statements)

References 23 publications

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“…In a recent study carried out in China, investigators reported that 77.5% of patients presented with AD after age 12 and suggested that late-onset AD is quite common [13]. Between 9% and 47% of cases of AD also appear de novo in adults (≥18 years), although the most widely accepted proportion is 9%-24.5% [2,5,15]. Among adults who develop AD, peak incidence occurs at age 20-40 years [20], although the disease does not completely subside after that.…”

Section: Epidemiologymentioning

confidence: 99%

“…Nummular eczema is very common, at least in Chinese and Indian adults with AD (about 17%) [5,13]. The lesions are round, inflamed sores that are located most often on the lower limbs (Figure 11).…”

Section: Nummular Eczemamentioning

confidence: 99%

“…Liu et al [13] reported that over 90% of Chinese dermatologists would respond to symmetrical flexural dermatitis with a diagnosis of contact eczema instead of AD. Furthermore, it is likely that clinicians worldwide share this inclination owing to poor familiarity or resistance to the idea of adult-onset AD [5].…”

Section: Diagnosismentioning

confidence: 99%

“…Bannister and Freeman [4] recently introduced the term adult-onset atopic dermatitis. This concept has received little attention in the literature compared with AD in children, despite the considerable impact of severe AD on adult patients, probably owing to a lack of acceptance or a lack of familiarity with the disease [5].…”

Section: Introductionmentioning

confidence: 99%

“…An estimated 18.5% of all cases of AD first appear in adulthood [14], usually in individuals aged 20 to 40 years but also in elderly patients, where clinicians rarely suspect AD. Moreover, this form includes clinical presentations that are rare in children (eg, nummular eczema, prurigo, and head-and-neck dermatitis), probably owing to the differing environmental exposures between these 2 age groups [5].…”

Section: Clinical Patternsmentioning

confidence: 99%

See 4 more Smart Citations

Atopic Dermatitis in Adults: A Diagnostic Challenge

Salvador¹,

Romero‐Pérez²,

Encabo-Durán³

2017

J Investig Allergol Clin Immunol

150

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Atopic dermatitis (AD) has a prevalence of 1%-3% in adults. Adult-onset AD has only been defined recently, and lack of familiarity with this condition and confusion regarding the appropriate terminology persist. AD may first appear in childhood or de novo in adults and is characterized by pronounced clinical heterogeneity. The disease often deviates from the classic pattern of flexural dermatitis, and there are forms of presentation that are specific to adults, such as head-and-neck dermatitis, chronic eczema of the hands, multiple areas of lichenification, or prurigo lesions. Although diagnosis is clinical, adult-onset AD frequently does not fit the traditional diagnostic criteria for the disease, which were developed for children. Thus, AD is often a diagnosis of exclusion, especially in de novo cases. Additional diagnostic tests, such as the patch test, prick test, skin biopsy, or blood test, are usually necessary to rule out other diseases or other types of eczema appearing concomitantly with AD. This article presents an update of the different forms of clinical presentation for AD in adults along with a proposed diagnostic approach, as new treatments will appear in the near future and many patients will not be able to benefit from them unless they are properly diagnosed. Key words: Atopic dermatitis. Adult. Diagnosis. Patch testing. Prick testing. ResumenLa dermatitis atópica (DA) en el adulto tiene una prevalencia del 1-3%. Es una entidad de reciente acuñamiento, que no todo el mundo conoce y sobre la que existe una gran confusión terminológica. Puede iniciarse en la infancia o presentarse de "novo" en el adulto. Presenta una gran heterogeneidad clínica y con frecuencia no sigue el patrón clásico de dermatitis flexural. Además, existen formas de presentación más propias de adulto como son la dermatitis de la cabeza y el cuello, eczema crónico de manos, áreas de liquenificación múltiple o lesiones de prurigo. Aunque su diagnóstico es clínico, muchas veces la DA del adulto no cumple los criterios diagnósticos "clásicos" de DA, pues están pensados para niños. Por eso, suele ser un diagnóstico de exclusión, sobre todo los casos de "novo". Suele precisar de la realización de pruebas diagnósticas para descartar otras enfermedades distintas u otro tipo de eczema sobreañadido a la DA. Las pruebas diagnósticas que pueden resultar útiles para ello son: pruebas epicutáneas, prick test, biopsia cutánea y una analítica sanguínea. Realizamos una actualización de las distintas formas de presentación clínica de la DA del adulto y establecemos unas pautas para llegar a su diagnóstico, pues en un futuro inmediato, con la aparición de nuevos tratamientos, muchos de estos pacientes no podrán beneficiarse de los mismos por no estar adecuadamente diagnosticados. Palabras clave: Dermatitis atópica. Adulto. Diagnóstico. Pruebas epicutáneas. Prick test.

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