An Italian multicentre study on adult atopic dermatitis: persistent versus adult-onset disease

Abstract

Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin disease which predominantly affects children. However, AD may persist until adulthood (persistent AD), or directly start in adults (adult-onset AD). AD often shows a non-flexural rash distribution, and atypical morphologic variants in adults and specific diagnostic criteria are lacking. Moreover, adult AD prevalence as well as detailed data which can characterize persistent vs adult-onset subtype are scant. The aim of this study was to investigate on the main features of adult AD particularly highlighting differences between persistent vs adult-onset form. An Italian multicentre observational study was conducted between April 2015-July 2016 through a study-specific digital database. 253 adult AD patients were enrolled. Familiar history of AD was negative in 81.0%. Erythemato-desquamative pattern was the most frequent clinical presentation (74.3%). Flexural surface of upper limbs was most commonly involved (47.8%), followed by eyelid/periocular area (37.9%), hands (37.2%), and neck (32%). Hypertension (7.1%) and thyroiditis (4.3%) were the most frequent comorbidities. A subgroup analysis between persistent (59.7%) vs adult-onset AD patients (40.3%) showed significant results only regarding AD severity (severe disease was more common in persistent group, p < 0.05), itch intensity (higher in adult-onset disease), and comorbidities (hypertension was more frequent in adult-onset group, p < 0.01). Adult AD showed uncommon features such as significant association with negative AD family history and lacking of association with systemic comorbidities respect to general population. No significant differences among persistent vs adult-onset subgroup were registered except for hypertension, itch intensity, and disease severity.

Association between Atopic Dermatitis and the Metabolic Syndrome: A Systematic Review

“…A positive association between AD and hypertension was observed in 6 out of 11 studies [1,2,15,18,22,24], 3 studies [12,17,23] found an inverse association, and 2 studies [19,32] did not find any association. The study by Uehara et al [12] with physician's diagnosed AD and measured blood pressure found no association.…”

Adult Atopic Dermatitis: Less Certainty, More Challenges

“…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).…”

Italian guidelines for therapy of atopic dermatitis—Adapted from consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis)

“…Atopic dermatitis (AD) is an inflammatory, itchy, chronic, or chronically relapsing skin disease, often associated with other atopic mucous membrane diseases, highly concordant in homozygous twins and an overall high family history (Hanifin & Rajka, ; Megna et al, ; Weidinger & Novak, ; Wollenberg et al, ). AD prevalence is 20% in children and 2–8% in adults, indeed 10% of the affected deserve a systemic treatment (Wollenberg et al, , , ).…”