Adult‐onset atopic dermatitis

Bannister, Michael J; Freeman, Susanne

doi:10.1046/j.1440-0960.2000.00442.x

Cited by 138 publications

(84 citation statements)

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“…A 9% rate of adult-onset AD in a patch test population has been reported [3]and, in another series, it was hypothesized that 1/3 of dermatitides diagnosed as ‘unclassified endogenous eczemas’ were in fact atypical late-onset ADs [10]. In a retrospective chart review, the clinical onset was after the age of 21 years in 13.6% of 492 AD patients [11].…”

Section: Discussionmentioning

confidence: 99%

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Adult-Onset Atopic Dermatitis in a Patch Test Population

Ingordo¹,

D’Andria²,

D’Andria³

2003

Dermatology

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Background: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. Objective: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. Methods: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0–3 years); childhood (4–11 years); adolescence (≧12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset ≤17 years). Results: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were ‘sole’ ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of ‘pure’ AD and ‘mixed’ AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. Conclusion: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.

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Section: Discussionmentioning

confidence: 99%

“…In the UK Working Party’s criteria, the onset before 2 years of age was considered a ‘major’ feature [2]. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen [3]. …”

Section: Introductionmentioning

confidence: 99%

Adult-Onset Atopic Dermatitis in a Patch Test Population

Ingordo¹,

D’Andria²,

D’Andria³

2003

Dermatology

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“…The prevalence of AD has increased worldwide over the past 30 years [3,4], to the extent that it is now one of the most common chronic diseases, affecting about a fifth of the population in developed countries. Prevalence in children is estimated at 15% to 30%, while in adults estimates range from 0.3% to 14.3% [13,15,17], with most authors agreeing that it stands between 1% and 3% [18].…”

Section: Epidemiologymentioning

confidence: 99%

“…However, it may persist into adulthood or present de novo during that period [1][2][3]. Bannister and Freeman [4] recently introduced the term adult-onset atopic dermatitis. This concept has received little attention in the literature compared with AD in children, despite the considerable impact of severe AD on adult patients, probably owing to a lack of acceptance or a lack of familiarity with the disease [5].…”

Section: Introductionmentioning

confidence: 99%

Atopic Dermatitis in Adults: A Diagnostic Challenge

Salvador¹,

Romero‐Pérez²,

Encabo-Durán³

2017

J Investig Allergol Clin Immunol

128

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Atopic dermatitis (AD) has a prevalence of 1%-3% in adults. Adult-onset AD has only been defined recently, and lack of familiarity with this condition and confusion regarding the appropriate terminology persist. AD may first appear in childhood or de novo in adults and is characterized by pronounced clinical heterogeneity. The disease often deviates from the classic pattern of flexural dermatitis, and there are forms of presentation that are specific to adults, such as head-and-neck dermatitis, chronic eczema of the hands, multiple areas of lichenification, or prurigo lesions. Although diagnosis is clinical, adult-onset AD frequently does not fit the traditional diagnostic criteria for the disease, which were developed for children. Thus, AD is often a diagnosis of exclusion, especially in de novo cases. Additional diagnostic tests, such as the patch test, prick test, skin biopsy, or blood test, are usually necessary to rule out other diseases or other types of eczema appearing concomitantly with AD. This article presents an update of the different forms of clinical presentation for AD in adults along with a proposed diagnostic approach, as new treatments will appear in the near future and many patients will not be able to benefit from them unless they are properly diagnosed. Key words: Atopic dermatitis. Adult. Diagnosis. Patch testing. Prick testing. ResumenLa dermatitis atópica (DA) en el adulto tiene una prevalencia del 1-3%. Es una entidad de reciente acuñamiento, que no todo el mundo conoce y sobre la que existe una gran confusión terminológica. Puede iniciarse en la infancia o presentarse de "novo" en el adulto. Presenta una gran heterogeneidad clínica y con frecuencia no sigue el patrón clásico de dermatitis flexural. Además, existen formas de presentación más propias de adulto como son la dermatitis de la cabeza y el cuello, eczema crónico de manos, áreas de liquenificación múltiple o lesiones de prurigo. Aunque su diagnóstico es clínico, muchas veces la DA del adulto no cumple los criterios diagnósticos "clásicos" de DA, pues están pensados para niños. Por eso, suele ser un diagnóstico de exclusión, sobre todo los casos de "novo". Suele precisar de la realización de pruebas diagnósticas para descartar otras enfermedades distintas u otro tipo de eczema sobreañadido a la DA. Las pruebas diagnósticas que pueden resultar útiles para ello son: pruebas epicutáneas, prick test, biopsia cutánea y una analítica sanguínea. Realizamos una actualización de las distintas formas de presentación clínica de la DA del adulto y establecemos unas pautas para llegar a su diagnóstico, pues en un futuro inmediato, con la aparición de nuevos tratamientos, muchos de estos pacientes no podrán beneficiarse de los mismos por no estar adecuadamente diagnosticados. Palabras clave: Dermatitis atópica. Adulto. Diagnóstico. Pruebas epicutáneas. Prick test.

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“…However, in approximately 50% of cases, it extends into adult life, evolving into a chronic lifelong condition 2, 3, 4. In addition, it is increasingly being recognized that AD can present for the first time in adults as adult‐onset AD 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey

Arima

Gupta

Gadkari

et al. 2018

The Journal of Dermatology

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Atopic dermatitis is a chronic inflammatory skin disease. The objective of this study was to characterize the burden of atopic dermatitis in Japanese adult patients relative to the general population. Japanese adults (≥18 years) with a self‐reported diagnosis of atopic dermatitis and adult controls without atopic dermatitis/eczema/dermatitis were identified from the 2013 Japan National Health and Wellness Survey. Atopic dermatitis patients were propensity‐score matched with non‐atopic dermatitis controls (1:2 ratio) on demographic variables. Patient‐reported outcome data on comorbidities, mood and sleep disorders, health‐related quality of life, work productivity and activity impairment, and health‐care resource utilization were analyzed in atopic dermatitis patients and matched controls. A total of 638 Japanese adult patients with atopic dermatitis were identified, of whom 290 (45.5%) rated their disease as “moderate/severe” and 348 (54.5%) as “mild”. The analysis cohort comprised 634 atopic dermatitis patients and 1268 matched controls. Atopic dermatitis patients reported a significantly higher prevalence of arthritis, asthma, nasal allergies/hay fever, anxiety, depression and sleep disorders compared with controls (all P < 0.001). Atopic dermatitis patients also reported a significantly poorer health‐related quality of life, higher overall work and activity impairment, and higher health‐care resource utilization (all P < 0.001). Self‐rated disease severity was not associated with disease burden, except for a significantly higher overall work and activity impairment. In conclusion, Japanese adult patients with atopic dermatitis reported a substantial disease burden relative to adults without atopic dermatitis, suggesting an unmet need for effective strategies targeting disease management.

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Adult‐onset atopic dermatitis

Cited by 138 publications

References 10 publications

Adult-Onset Atopic Dermatitis in a Patch Test Population

Adult-Onset Atopic Dermatitis in a Patch Test Population

Atopic Dermatitis in Adults: A Diagnostic Challenge

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey

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