Atopic Dermatitis in the Adult Population

Abstract

Atopic Dermatitis (AD) is a chronic inflammatory disease of the skin characterized by cutaneous findings of dry skin, erythematous scaly papules, or plaques, and lichenification. The hallmark of AD is pruritis, which drives most of the disease burden. While this disease is thought to primarily affect children, it commonly affects adults as well [1]. In the adult population, AD may be persistent from childhood, relapsing AD that was thought to be resolved, or adult-onset AD. Although AD is commonly seen in the adult population and is associated with a significant disease burden, many providers are inadequately educated about the recognition and treatment of AD in adults. This paper will review the clinical features, pathophysiology, diagnosis, treatment, and management of AD in the adult population. Working to better understand AD and its impact on patients may be beneficial in minimizing the burden of this disease on the adult population. Check for updatesAD patients have a family history of atopy [8]. There are also several genes associated with an increased risk for AD, many of which code for proteins involved in the skin barrier or immune regulation [9]. One major genetic alteration associated with an increased risk for AD is a loss-of-function mutation in the FLG gene. This gene codes for the filaggrin protein, which is a component of natural moisturizing factors and is key for the barrier function of the skin.Environmental risk factors include living in an urban area, stress, increased domestic water hardness, exposure to irritants (e.g., tobacco smoke), increased adiposity, and a Western diet [10]. It is also believed that increased exposure to pathogens early in life can be protective against AD, termed the "hygiene hypothesis." This hypothesis theorizes that exposure to dirt and pathogens early in life can steer the immune system away from allergic inflammation [11]. This hypothesis may explain regional differences in the incidence of AD, as well as the increasing prevalence of AD over the past half-century [10].