Atopic Dermatitis in Adults

Licia Zeppa; Veronica Bellini; Paolo Lisi


Dermatitis. 2011;22(1):40-46. 

In This Article

Materials and Methods

From January 2004 to December 2007, 332 consecutive AD subjects older than 18 years (145 males [43.7%; mean age, 29.9 yr] and 187 females [56.3%; mean age, 30.9 yr]) were investigated in our outpatient section after written informed consent was obtained. In all enrolled subjects, AD was diagnosed according to the criteria of Hanifin and Rajka.[12]

The clinical data (family history of AD, family or personal history of rhinoconjunctivitis or bronchial asthma or both, age at onset of cutaneous lesions, and morphology and localization of dermatitis in the 3 years before our clinical examination) and the results of investigations (serum total IgE, skin-prick tests, and patch tests) were collected in a record for statistical analysis. The chi-square test and Fisher exact test were used to analyze the results, and p values of less than .05 were regarded as significant.

Serum total IgE level was determined with radioimmunoassay. Levels greater than 100 IU/mL were considered abnormal. Skin-prick tests were carried out on the volar surface of the forearm according to the criteria established by the Società Italiana di Allergologia e Immunologia Clinica (SIAIC).[14] A series of 20 allergen extracts (inhalants, pollens, and foods), histamine dihydrochloride (10 mg/mL) as positive control, and saline as negative control (Lofarma, Milan, Italy) were used. Patch testing was carried out on each patient's back with the Società Italiana di Dermatologia Allergologica Professionale e Ambientale Vsidapa standard series (FIRMA, Florence, Italy) according to criteria established by the Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA).[15] Van der Bend Square Chambers (van der Bend B.V., Brielle, the Netherlands) were used, and only strong positive reactions (++ and +++) were considered.

Oral corticosteroids, antihistamines, and ultraviolet therapy were discontinued at least 3 weeks before the skin tests. No topical corticosteroids or immunosuppressive agents were used at the time of testing.

On the basis of clinical data, results of skin tests, and total serum IgE, the patients were separated into two groups (IAD and EAD patients) according to the criteria proposed by Wüthrich.[3] The results were evaluated in their entirety but also by comparing the two groups.

The Eczema Area and Severity Index (EASI) was used for scoring the severity of dermatitis.[16] The EASI is a composite index that includes an assessment of the percentage of area involved in each of the four body regions (head and neck, upper limbs, trunk, and lower limbs) and an assessment of four clinical signs (erythema, infiltration or papulation, excoriation, and lichenification). The sum of these scores gives the EASI total, which could range from 0 to 72 (the maximum score).

In this study, the severity of AD was graded as mild (EASI score < 8), moderate (EASI score of 8–15), or severe (EASI score > 15).[17,18]

The study was approved by the local ethics committee (Comitato Etico Aziende Sanitarie Umbria, Perugia, Italy).


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