Clinical Features of Adult/Adolescent Atopic Dermatitis and Chinese Criteria for Atopic Dermatitis

Abstract

Background:Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczema/AD and to propose Chinese diagnostic criteria for adult/adolescent AD.Methods:A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients (12 years and over) with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software.Results:A total of 2662 valid questionnaires were collected (1369 male and 1293 female). Of all 2662 patients, 2062 (77.5%) patients had the disease after 12 years old, while only 600 (22.5%) patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine (80.4%) patients had the disease for more than 6 months. One thousand one hundred and forty-four (43.0%) patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight (58.2%) patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients.Conclusion:Late-onset of eczema or AD is common. The clinical manifestations of AD are heterogeneous. We have proposed Chinese diagnostic criteria for adolescent and adult AD, which are simple and sensitive for diagnosis of adult/adolescent AD.

Prevalence and Clinical Features of Atopic Dermatitis in China

“…In addition, the awareness of AD by dermatologists and patients may also contribute to this phenomenon. In China, the symmetrical eczematous dermatitis tends to be diagnosed as eczema in the past decades, indicating an overdiagnosed eczema and underdiagnosed AD [7]. Until recent years, we began to pay attention to AD and have improved the accuracy of diagnosis.…”

“…Intriguingly, few studies have paid attention to AD patients of all ages, despite the fact that the occurrence of AD among adults has been shown to significantly affect socioeconomic conditions in both Asian and Western countries [6]. A recent survey has investigated clinical features of adult/adolescent (12 years and over) AD [7], but the epidemiology of AD at all ages in China is yet to be elucidated. Therefore, the purpose of the current study is to determine the actual prevalence and clinical features of AD at all ages in outpatients with dermatitis and eczema across large tertiary hospitals in China.…”

Burden of atopic dermatitis in Asia

“…Chinese diagnostic criteria specific for adult/adolescent AD have been proposed because adult‐onset AD is common within the Chinese population . The criteria require a patient to have symmetrical eczema for more than 6 months and one or more of the following: a personal or family history of atopic disease, elevated serum immunoglobulin (Ig)E levels, positive allergen‐specific IgE or eosinophilia …”

It is time to consider global variations in the clinical phenotype: a commentary on the new diagnostic criteria for atopic dermatitis in children in China

“…In the recent years, in an effort to address this critical issue, a group of Chinese dermatologists lead by Prof. Yao from Jiao Tong University in Shanghai have published a series of studies dealing with the appropriateness of the classical diagnostic criteria such as those of Hanifin and Rajka and the UK working party for the diagnosis of AD in the Chinese paediatric population . In a first approach and previous publications, this group clearly showed that the stringent application of the Hanifin and Rajka criteria in Chinese children leads to a significant underestimation of the diagnosis of AD in this population when compared to the results obtained by clinically experienced dermatologists .…”