Atopic Dermatitis in Adults

Licia Zeppa; Veronica Bellini; Paolo Lisi

Disclosures

Dermatitis. 2011;22(1):40-46. 

In This Article

Abstract and Introduction

Abstract

Atopic dermatitis (AD) is a chronically relapsing eczematous disease, more common in infants and children than in adults and very rare after midlife. The diagnosis of AD is not always easy in adults, especially when the extension of lesions is limited and their distribution atypical. The aim of this study was to investigate epidemiologic and clinical features of adult AD. The medical files of 332 consecutive AD patients were reviewed to ascertain family and personal history of atopy, age at onset, morphology and localization sites of AD lesions, serum total immunoglobulin E levels, skin prick-test and patch-test results. The present study has show that the disease is more frequent in females and during the third decade of life, starts after the 18th year in slightly fewer than half the patients (47.6%), is prevalently localized in the limb flexures, eyelids, and perioral region, but also in the forehead, cheeks, and anterolateral region of the neck, where it is mainly mild to moderate. AD is of the intrinsic type in 30.4% of cases. Positive patch-test reactions to chemical allergens have been observed in 23.8% of patients. These are very important, because they may influence the occupational choices and the development of hand dermatitis.

Introduction

Atopic Dermatitis (AD) is a common chronically relapsing inflammatory skin disease characterized by itching eczematous lesions that are symmetrically distributed in peculiar sites and are associated with xerosis and often with atopic habitus.[1] Atopy is a personal or familial tendency to produce immunoglobulin E (IgE) antibodies in response to low doses of allergens (usually proteins) and to develop typical symptoms such as asthma, rhinoconjunctivitis, and eczema or dermatitis.[2]

In 1983, Wüthrich proposed to divide patients with the clinical phenotype of AD into two subtypes: ''intrinsic'' (or ''nonallergic'') AD and ''extrinsic'' (or ''classic'' or ''allergic'') AD.[3] Intrinsic AD (IAD) is characterized by an absence of association with other atopic diseases, negative prick-test results for common inhalant and food allergens, normal total serum IgE level, and a lack of allergen-specific serum IgE antibodies to common aeroallergens and food allergens. Conversely, extrinsic AD (EAD) is associated with allergy to aeroallergens or food allergens.

AD can occur at any age, but it is more common in infants and children. The lesions arise in the first year of life in the majority (at least 60%) of cases and before 5 years of age in another 30% of cases.[4] The disease appears after age 20 in only 2% of patients,[5] and it is rare after midlife.[6] However, the frequency of AD in adults is much higher because the skin lesions do not improve with time in 30 to 60% of infants or young children.[7,8] The incidence of AD has been increasing over the past three to four decades, especially in the higher social classes and in countries with greater economic development.[9] It is estimated that 10 to 15% of the children living in industrialized regions[10] and 2 to 10% of adults[11] are affected by AD.

The diagnosis of AD is generally clinical, but diagnosis is not always easy with adults, particularly when the extension of lesions is limited, when the lesions' distribution is atypical, when the minor cutaneous atopy signs are not present, and when atopic mucous manifestations are not associated. In many cases, the most commonly employed diagnostic criteria (such as those of Hanifin and Rajka[12] and those of the UK Working Party[13]) cannot be satisfactory, especially when AD starts when the patient is more than 18 years of age.

The aim of this prospective study was to investigate epidemiologic and clinical features of adult AD.

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