Atopic dermatitis in older patients: particular points

Abstract

We review the particular characteristics of atopic dermatitis (AD) in adult life, and compare findings with those of AD in childhood. AD affects 1-3% of adults world-wide, and can present as adult-onset AD, or as infantile/childhood AD that persists, or recurs after many years. Eczema in adults usually exists for years, compromising quality of life, sex life and occupational choices. The flexural areas, shoulders, head-and-neck, and hands are typically affected. In elderly adults, eczematous erythroderma is common. The intrinsic (non-IgE-allergic) eczema subtype affects 5-15% of cases. Classical food allergy has a low importance, although non-IgE-mediated and pseudoallergic reactions can cause eczema. Sensitivity to aeroallergens, especially dust mite, is demonstrated in the majority of adult AD patients, including elderly adults, by immunoglobulin E-mediated tests and/or atopy patch tests. Occupational allergic and irritant contact dermatitis is increased. In adults, as in children, Staphylococcus aureus colonization is very high, whereas adult skin is more heavily colonized with Malassezia yeasts. Immediate and delayed sensitization to Malassezia sympodialis is specific for intrinsic and extrinsic AD, occurring especially in head-and-neck eczema. Concerning therapy, older patients are prone to certain adverse drug effects. In conclusion, differences exist between childhood and adult disease. As we should be seeing more adults with AD in the future, there is a need for more clinical and immunological studies in older patients.

Atopic Dermatitis in Adults: A Diagnostic Challenge

“…Studies show that at least 5%-15% of atopic patients do not present with high total IgE (this is known as intrinsic AD) [15]. More recent diagnostic criteria-specific to adolescents and adults-have been proposed from China and include only 3 items, thus making them quite practical.…”

“…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]. While considerably lower in the elderly (>65 years), the percentage of cases in this age group is increasing in industrialized countries [15].…”

“…Although AD can appear at any time during an individual's life, about 60% of cases are thought to present during the first year [17], and 60%-74% of cases in children resolve before the age of 16, with the rest persisting into adulthood [15]. However, this supposed rate of clearance is probably around 53% owing to relapses over the course of adolescence and early adulthood.…”

Senile Atopic Dermatitis Patients’ Profile in Geriatric Outpatient Clinic Dermatovenereology Department Cipto Mangunkusumo Hospital in 2011-2015

“…This may due to the number of cases that are not too much. Although the number is relatively small compared to childhood AD, the prevalence of adult AD is increasing in developing countries [5][6][7]. One study shows that the prevalence of AD in adult and elderly is 1% to 3% [8].…”

Fungus as an Exacerbating Factor of Atopic Dermatitis, and Control of Fungi for the Remission of the Disease

“…The most common skin infections in AD patients are caused by Staphylococcus aureus and herpes simplex virus (Ong & Leung, 2010). S. aureus is frequently detected in AD patients (Abeck & Mempel, 1998;Katsarou & Armenaka, 2011) and becomes an aggravating factor. In addition, toxins, such as staphylococcal enterotoxins and toxic shock syndrome toxin-1 (McFadden et al, 1993;Bunikowski et al, 1999), generated from S. aureus may act as superantigens Niebuhr et al, 2011;Yeung et al, 2011).…”