Adult-Onset Atopic Dermatitis: Characteristics and Management

Paras P. Vakharia; Jonathan I. Silverberg


Am J Clin Dermatol. 2019;20(6):771-779. 

In This Article

Abstract and Introduction


Recent epidemiological studies found the US prevalence of atopic dermatitis in adults to be approximately 7%. In particular, one in four adults with atopic dermatitis report adult onset of their disease. Adult-onset compared to child-onset atopic dermatitis is associated with distinct risk factors, lesional distribution and morphology, associated signs, genetics, and comorbidities. Adult-onset atopic dermatitis is a clinical diagnosis, and must be distinguished from other entities in the differential diagnosis, e.g., allergic contact dermatitis and cutaneous T-cell lymphoma. Further research is necessary to better understand the pathogenesis and optimal treatment approaches in adult-onset/recurrent atopic dermatitis.


Atopic dermatitis (AD) is a chronic inflammatory skin disease that has been conservatively estimated to have annual medical costs in the USA of US$5.2 billion.[1] Atopic dermatitis is a heterogeneous disease with a broad spectrum of clinical manifestations. A recent systematic review and meta-analysis of 101 studies identified 78 different clinical signs and characteristics of AD, with considerable variability by global region and patient age.[2] In addition, there is a complex constellation of symptoms in AD, including pruritus, xerosis, pain, and sleep disturbance, which leads to a large impairment in quality of life.[3–5]

Atopic dermatitis is thought to occur via a combination of genetic, environmental, and immunologic factors.[6–8] A compromised skin barrier results in increased transepidermal water loss and transcutaneous penetration of microbes and allergens, and ultimately can trigger an inflammatory cascade.[9–11] T-helper cell (Th) type 2 and other T-cell subsets contribute to the pathogenesis of AD. In the acute and chronic phases of AD, a skewed Th2 response is seen, leading to increased activity of interleukin (IL)-4, IL-5, IL-13, and IL-31. Whereas, Th1 responses are upregulated in the chronic phase of AD.

Atopic dermatitis was once thought to be primarily a pediatric disease that remitted with increasing age. However, recent epidemiological studies showed that AD is a heterogeneous disease that can start and persist throughout the life course. This review focuses on adult-onset AD, which has a unique epidemiology, pathophysiology, and clinical presentation.