Atopic Dermatitis in Adults

Licia Zeppa; Veronica Bellini; Paolo Lisi


Dermatitis. 2011;22(1):40-46. 

In This Article


AD was mild in 88 patients (26.5%), moderate in 62 patients (18.7%), and severe in 182 patients (54.8%). Of these 332 AD patients, 167 (50.3%), 94 (28.3%), 47 (14.2%), 16 (4.8%), and 8 (2.4%) were aged 18 to 27 years, 28 to 37 years, 38 to 47 years, 48 to 57 years, and more than 57 years, respectively.

The distribution of age at the onset of AD is shown in Table 1. The eczematous lesions appeared after age 18 for 158 patients (47.6%), without statistically significant difference in regard to sex (47.1% for females vs 48.3% for males). In only a quarter of cases (25.9% [28.9% in males, 23.5% in females]) did the lesions appear during the first 3 years of life.

A positive family history of atopic diseases (AD or mucosal atopy) was found in the first-degree relatives of 122 subjects (36.7%). Seventy-six of these were females (40.6% of 187 females), and 46 males (31.7% of 145 males), but the sex-related difference was not statistically significant. Also, the age of AD onset was not influenced by family atopy because the skin lesions appeared in the first 18 years of life in 64 of 174 subjects (36.8%) and after the eighteenth year of life in 58 of 156 subjects (36.7%).

Personal mucosal atopy (rhinoconjunctivitis, asthma, or both) occurred in 192 AD subjects (57.8%), without significant statistical difference between males (94 of 145 [64.8%]) and females (98 of 187 [52.4%]) or between AD onset before (93 of 174 [53.4%]) and after (99 of 158 [62.6%]) the eighteenth year of life.

In 94.5% of cases, the involved skin was more or less reddened, lichenified, and covered with whitish pityriasiform scales, hemorrhagic and sometimes honey-colored crusts, linear scratch marks, and fissures. The skin lesions were distributed symmetrically. The hair was dry and lusterless when the lesions were localized on the scalp (6.1%), but a pronounced loss was observed only in four cases (1.2%). Asteatosis of clinically healthy skin and pruritus were nearly constant (91.9%) and were very severe in a third of cases. Nummular (15 patients), seborrheic dermatitis–like (7 patients), and prurigo-like (5 patients) patterns were the most prevalent morphologic types of dermatitis.

The body-site distribution of lesions in the 3 years before our clinical examination is reported in Table 2. Upper limbs (62.6%) were the main sites of involvement; in this area, the lesions were most commonly located on the antecubital flexures (32.8%) and hands (15.7%). The other sites were the face (44.9%) (particularly the eyelids, perioral region, forehead, and cheeks), lower limbs (36.1%) (above all, the popliteal flexures), neck (22.0%) (mainly the anterolateral surface), and trunk (20.8%). In regard to sex, the forehead and cheeks of females and the thighs, legs, and feet of males were significantly more often involved (p < .05). Dermatitis was localized in the nipple area only in two females, and the elbows were grayish, asteatotic, and keratotic in five patients.

Serum total IgE levels were elevated in 205 (61.7%) patients, without statistically significant differences in regard to sex (males: 92 of 145 [63.4%]; females: 113 of 187 [60.4%]) or the age of AD onset (before the eighteenth year: 111 of 174 [63.8%]; after the eighteenth year: 94 of 158 [59.5%]). IgE levels greater than 300 IU/mL were observed in 88 (26.5%) patients (43 males and 45 females).

One or more positive prick-test reactions to aeroallergens and food allergens were seen in 227 subjects (68.4%). These reactions were significantly more common in males (111 [76.5%]) than in females (116 [62.0%]) (p < .01). Inhalants (178 [92 males and 86 females]) and pollens (175 [87 males and 88 females]) were more frequently involved than foods (37 [18 males and 19 females]) (Table 3).

Of the 79 patients (23.8%) who had positive patch-test results, 25/145 (17.2%) were males and 54/187 (28.9%) were females. Twenty-three patients had multiple sensitivity. Statistical analysis showed a significant correlation to female sex (p < .05). The most common causes of positive reactions were nickel sulfate (39 patients [49.4%]), cobalt chloride (10 [12.7%]), fragrance mix (9 [11.4%]), and potassium dichromate (8 [10.1%]). The relevance of positive reactions remained unexplained for 6 of 10 patients sensitized to cobalt chloride (all sensitized to nickel sulfate) and for 2 of 8 patients sensitized to potassium dichromate.

On the basis of the results, EAD was diagnosed in 231 subjects (69.6%) (115 males and 116 females; mean age, 31.6 yr), and IAD was diagnosed in 101 subjects (30.4%) (30 males and 71 females; mean age, 27.1 yr). There were no significant differences between the two AD subgroups in the frequency of the age at lesion onset (Table 4) and the localization site (Table 5), whereas familial atopy was significantly more frequent for EAD subjects (89 [38.5%]) than for IAD subjects (33 [32.7%]), especially for those whose lesions appeared after age 18 (EAD group: 38 of 114 [33.3%]; IAD group: 3 of 44 [6.8%]; p < .01). Positive patch-test reactions were observed in 51 (22.1%) EAD patients and 28 (27.7%) IAD patients, without qualitative differences (Table 6).


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