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Atopic Dermatitis in the Aged

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Textbook of Aging Skin

Abstract

Atopic dermatitis (AD) is an inflammatory, pruritic, and chronic, or chronically relapsing, skin disease occurring often in families with other atopic diseases. It occurs most frequently in infancy and childhood but also affects adults and elderly population (>65 years old). Over the last decades, the prevalence of AD increased substantially.

Adult AD includes patients with a persistent AD since childhood and those with a late-onset AD. Usually the disease exists for years, compromising quality of life, sex life, and occupational choices. The extrinsic type of AD is more common in adults than in children. Contact allergens and aeroallergens seem to play an important role in exacerbating AD. The disease is more frequent in females during the third decade, although in elderly patients (>65 years old), a male predominance is reported. Clinical features of AD differ characteristically according to the age of patients. In adults and senile patients, the disease (AD) often presents with atypical clinical manifestations, which sometimes make the diagnosis very difficult.

As we might be seeing more adults with AD in the future, there is a need for more studies in older patients, because until today a small number of manuscripts have been published on adult AD compared to the literature devoted to AD in children. In this chapter, the particular characteristics of AD in adult life such as epidemiology, quality of life, diagnostic criteria, clinical features, allergic triggers or irritating factors, pathogenesis, and treatment are discussed.

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References

  1. Williams HC. Epidemiology of atopic dermatitis. Clin Exp Dermatol. 2000;25:522–9.

    Article  CAS  PubMed  Google Scholar 

  2. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259–60. A systematic review provides evidence for an inverse relationship between atopic dermatitis and exposure to endotoxin, and animals in early life.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Flohr C, Pascoe D, Williams HC. Atopic dermatitis and the ‘hygiene hypothesis’: too clean to be true? Br J Dermatol. 2005;152(2):202–16.

    Article  CAS  PubMed  Google Scholar 

  4. McFadden JP, Dearman RJ, White JM, Basketter DA, Kimber I. The Hapten-Atopy hypothesis II: the ‘cutaneous hapten paradox’. Clin Exp Allergy. 2011;41(3):327–37.

    Article  CAS  PubMed  Google Scholar 

  5. Hanifin JM, Reed ML. Eczema prevalence in the United States. Dermatitis. 2007;18(2):82–91.

    Article  PubMed  Google Scholar 

  6. Wolkewitz M, Rothenbacher D, Low M, Stegmaier C, Ziegler H, Radulescu M, Brenner H, Diepgen TL. Lifetime prevalence of self-reported atopic diseases in a population-based sample of elderly subjects: results of ESTHER study. Br J Dermatol. 2007;156(4):693–7.

    Article  CAS  PubMed  Google Scholar 

  7. Bannister MJ, Freeman S. Adult-onset atopic dermatitis. Australas J Dermatol. 2000;41(40):225–8.

    Article  CAS  PubMed  Google Scholar 

  8. Tay Y, Khoo BP, Goh CL. The profile of atopic dermatitis in a tertiary dermatology outpatient clinic in Singapore. Int J Dermatol. 1999;38:689–92.

    Article  CAS  PubMed  Google Scholar 

  9. Nnoruka EN. Current epidemiology of atopic dermatitis in south–eastern Nigeria. Int J Dermatol. 2004;43:739–44.

    Article  PubMed  Google Scholar 

  10. Tanei R, Katsuoko K. Clinical analysis of atopic dermatitis in the aged. J Dermatol. 2008;35(9):562–9.

    Article  PubMed  Google Scholar 

  11. Folster-Holst R, Pape M, Buss YL, Christophers E, Weichenthal M. Low prevalence of the intrinsic form of atopic dermatitis among adult patients. Allergy. 2006;61(5):629–32.

    Article  CAS  PubMed  Google Scholar 

  12. Sandström Falk MH, Faergemann J. Atopic dermatitis in adults: does it disappear with age? Acta Derm Venereol. 2006;86(2):135–9.

    PubMed  Google Scholar 

  13. Katsarou A, Armenaka M. Review article. Atopic dermatitis in older patients: particular points. J Eur Acad Dermatol Venereol. 2011;25(1):12–8.

    Article  CAS  PubMed  Google Scholar 

  14. Furue M. History of atopic dermatitis. In: Tamaki K, Furue M, Nakagawa H, editors. Atopic dermatitis and topical steroid therapy. Shinjuku: Chugai-Igakusha; 1998. p. 1–19.

    Google Scholar 

  15. Masutaka F, Takahito C, Satoshi T. Current status of atopic dermatitis in Japan. Asia Pac Allergy. 2011;1:64–72.

    Article  Google Scholar 

  16. Furue M, Yamazaki S, Jimbow K, Tsuchida T, Amagai M, Tanaka T, Matsunaga K, Muto M, Morita E, Akiyama M, Soma Y, Terui T, Manabe M. Prevalence of dermatological disorders in Japan: a nationwide, cross-sectional, seasonal, multicenter, hospital-based study. J Dermatol. 2011;38(4):310–20.

    Article  PubMed  Google Scholar 

  17. Sandström MH, Faergemann J. Prognosis and prognostic factors in adult patients with atopic dermatitis: a long-term follow-up questionnaire study. Br J Dermatol. 2004;1:103–10.

    Article  Google Scholar 

  18. Schmitt J, Meurer M, Klon M, Frick KD. Assessment of health state utilities of controlled psoriasis and atopic eczema: a population-based study. Br J Dermatol. 2008;158(2):351–9.

    Article  CAS  PubMed  Google Scholar 

  19. Holm EA, Wulf HC, Stegmann H, Jemec GB. Life quality assessment among patients with atopic eczema. Br J Dermatol. 2006;154(4):719–25.

    Article  CAS  PubMed  Google Scholar 

  20. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)- a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210–6.

    Article  CAS  PubMed  Google Scholar 

  21. Holm EA, Esmann S, Jemec GB. The handicap caused by atopic dermatitis- sick leave and job avoidance. J Eur Acad Derm Venereol. 2006;20(3):255–9.

    Article  CAS  Google Scholar 

  22. Silverberg JI. Association between adult atopic dermatitis, cardiovascular disease and increased heart attacks in 3 population-based studies. Allergy. 2015. doi:10.1111/all.12685. Epub ahead of print.

    PubMed  Google Scholar 

  23. Wüthrich B, Schmid-Grendelmeier P. Definition and diagnosis of intrinsic versus extrinsic atopic dermatitis. In: Bieber T, Leung DYM, editors. Atopic dermatitis. New York: Marcel Dekker; 2002. p. 1–20.

    Chapter  Google Scholar 

  24. Van Leent EJM, Bos JD. Atopic dermatitis. In: Katsambas A, Lotti T, editors. European handbook of dermatological treatments. 2nd ed. Berlin: Springer-Verlag; 2003. p. 54–62.

    Chapter  Google Scholar 

  25. Tanei R. Atopic dermatitis in the elderly. Inflamm Allergy Drug Targets. 2009;8:398–404.

    Article  CAS  PubMed  Google Scholar 

  26. Rym BM, Mourad M, Bechir Z, et al. Erythroderma in adults: a report of 80 cases. Int J Dermatol. 2005;44(9):731–5.

    Article  PubMed  Google Scholar 

  27. Katoh N, Hirano S, Kishimoto S. Prognostic factor of adult patients with atopic dermatitis. J Dermatol. 2008;35:477–83.

    Article  PubMed  Google Scholar 

  28. Kanwar AJ, Narang T. Adult onset atopic dermatitis: under-recognized or under-reported? Indian Dermatol Online J. 2013;4(3):167–71.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980;92(Suppl):44–7.

    Google Scholar 

  30. Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, Bingham EA, Finlay AY, Pembroke AC, Graham-Brown RA, et al. The U.K. Working Party’s diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131(3):383–96.

    Article  CAS  PubMed  Google Scholar 

  31. Brenninkmeijer EEA, Schram ME, Leeflang MMG, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158:754–65.

    Article  CAS  PubMed  Google Scholar 

  32. Wedi B, Kapp A. Differential diagnosis of atopic eczema. In: Ring J, Przybilla B, Ruzicka T, editors. Handbook of atopic eczema. 2nd ed. Berlin\Heidelberg: Springer; 2006. p. 100–7.

    Chapter  Google Scholar 

  33. Stalder JF, Taieb A. Severity scoring of atopic dermatitis: the SCORAD index. Consensus report of the European Task Force on atopic dermatitis. Dermatology. 1993;186:23–31.

    Article  Google Scholar 

  34. Morar N, Willis-Owen SA, Moffatt MF, Cookson WO. The genetics of atopic dermatitis. J Allergy Clin Immunol. 2006;118:24–34.

    Article  CAS  PubMed  Google Scholar 

  35. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRAC-TALL Consensus Report. Allergy. 2006;61:969–87.

    Article  CAS  PubMed  Google Scholar 

  36. Irvine AD. Fleshing out filaggrin phenotypes. J Invest Dermatol. 2007;127:504–7.

    Article  CAS  PubMed  Google Scholar 

  37. Rupnik H, Rijavec M, Korošec P. Filaggrin loss-of-function mutations are not associated with atopic dermatitis that develops in late childhood or adulthood. Br J Dermatol. 2015;172(2):455–61.

    Article  CAS  PubMed  Google Scholar 

  38. Heede NG, Thyssen JP, Thuesen BH, Linneberg A, Johansen JD. Anatomical patterns of dermatitis in adult filaggrin mutation carriers. J Am Acad Dermatol. 2015;72(3):440–8.

    Article  CAS  PubMed  Google Scholar 

  39. Aalto-Korte K. Improvement of skin barrier function during treatment of atopic dermatitis. J Am Acad Dermatol. 1995;33:969–72.

    Article  CAS  PubMed  Google Scholar 

  40. Kabashima K. New concept of the pathogenesis of atopic dermatitis: interplay among the barrier, allergy, and pruritus as a trinity. J Dermatol Sci. 2013;70(1):3–11.

    Article  PubMed  Google Scholar 

  41. Cork M, Robinson DA, Vassilopoulos Y, Ferguson A, Moustafa M, MacGowan A, Duff GW, Ward SJ, Tazi-Ahnini R. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environmental interactions. J Allergy Clin Immunol. 2006;118:3–21.

    Article  CAS  PubMed  Google Scholar 

  42. Jin K, Higaki Y, Tagagi Y, Higuchi K, Yada Y, Kawashima M, Imo-kawa G. Analysis of beta-glucocerebrosidase and ceramidase activities in atopic and aged dry skin. Acta Derm Venereol. 1994;74(5):337–40.

    CAS  PubMed  Google Scholar 

  43. De Benedetto A, Kubo A, Beck L. Skin barrier disruption: a requirement for allergen sensitization? J Invest Dermatol. 2012;132:949–63.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Leung DYM, Bieber T. Atopic dermatitis. Lancet. 2003;361:151–60.

    Article  PubMed  Google Scholar 

  45. Bonness S, Bieber T. Molecular basis of atopic dermatitis. Curr Opin Allergy Clin Immunol. 2007;7:382–6.

    Article  CAS  PubMed  Google Scholar 

  46. Biedermann T. Dissecting the role of infections in atopic dermatitis. Acta Derm Venereol. 2006;86:99–109.

    CAS  PubMed  Google Scholar 

  47. Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC, NISC Comparative Sequencing Program, Bouffard GG, Blakesley RW, Murray PR, Green ED, Turner ML, Segre JA. Topographical and temporal diversity of the human skin microbiome. Science. 2009;324(5931):1190–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Oh J, Conlan S, Polley EC, Segre JA, Kong HH. Shifts in human skin and nares microbiota of healthy children and adults. Genome Med. 2012;4(10):77.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Naik S, Bouladoux N, Wilhelm C, Molloy MJ, Salcedo R, et al. Compartmentalized control of skin immunity by resident commensals. Science. 2012;337:1115–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Kong HH, Oh J, Deming C, Conlan S, Grice EA, Beatson MA, Nomicos E, Polley EC, Komarow HD, NISC Comparative Sequence Program, Murray PR, Turner ML, Segre JA. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012;22(5):850–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Gueniche A, Knaudt B, Schuck E, Volz T, Bastien P, Martin R, Röcken M, Breton L, Biedermann T. Effects of nonpathogenic gram-negative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study. Br J Dermatol. 2008;159(6):1357–63.

    Article  CAS  PubMed  Google Scholar 

  52. Worm M, Forschner K, Lee H-H, Roehr CC, Edenharter G, Niggemann B, Zuberbier T. Frequency of atopic dermatitis and relevance of food allergy in adults in Germany. Acta Derm Venereol. 2006;86:119–22.

    PubMed  Google Scholar 

  53. Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rance’ F, Turjanmaa K, Worm M. Eczematous reactions to foods in atopic eczema: position paper of the EAACI and GA2LEN. Allergy. 2007;62:723–8.

    Article  CAS  PubMed  Google Scholar 

  54. Worm M, Ehlers I, Sterry W, Zuberbier T. Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy. 2000;30:407–14.

    Article  CAS  PubMed  Google Scholar 

  55. Erwin EA, Platts-Mills TAE. Aeroallergens. In: Bieber T, Leung D, editors. Atopic dermatitis. New York: Markel Dekker; 2002. p. 357–73.

    Chapter  Google Scholar 

  56. Mediaty A, Neuber K. Total and specific serum IgE decreases with age in patients with allergic rhinitis, asthma and insect sting allergy but not in patients with atopic dermatitis. Immunity Ageing. 2005;2:9.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Samochocki Z, Owczarek W, Zabielski S. Can atopy patch tests with aeroallergens be an additional diagnostic criterion for atopic dermatitis? Eur J Dermatol. 2006;16:151–4.

    PubMed  Google Scholar 

  58. Baker BS. The role of microorganisms in atopic dermatitis. Clin Exp Immunol. 2006;144:1–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Roll A, Cozzio A, Fischer B, Schmid-Grendelmeier P. Microbial colonization and atopic dermatitis. Curr Opin Allergy Clin Immunol. 2004;4:373–8.

    Article  PubMed  Google Scholar 

  60. Takahata Y, Sugita T, Kato H, Nishikawa A, Hiruma M, Muto M. Cutaneous Malassezia flora in atopic dermatitis differ between adults and children. Br J Dermatol. 2007;157:1178–82.

    Article  CAS  PubMed  Google Scholar 

  61. Löffler H, Steffes A, Happle R, Effendy I. Allergy and irritation: an adverse association in patients with atopic eczema. Acta Derm Venereol. 2003;83:328–31.

    Article  PubMed  Google Scholar 

  62. Dotterud LK, Smith-Sivertsen T. Allergic contact sensitization in the general adult population: a population-based study from Northern Norway. Contact Dermatitis. 2007;56:10–5.

    Article  CAS  PubMed  Google Scholar 

  63. Laminitausta K, Kalimo K, Fagerlund VL. Patch test reactions in atopic patients. Contact Dermatitis. 1992;26:234–40.

    Article  Google Scholar 

  64. De Groot AC. The frequency of contact allergy in atopic patients with dermatitis. Contact Dermatitis. 1990;22:273–7.

    Article  PubMed  Google Scholar 

  65. Dickel H, Bruckner TM, Schmidt A, Diepgen TL. Impact of atopic skin diathesis on occupational skin disease incidence in a working population. J Invest Dermatol. 2003;121:37–40.

    Article  CAS  PubMed  Google Scholar 

  66. Koblenzer C. The psychological aspects of atopic dermatitis. In: Bieber T, Leung D, editors. Atopic dermatitis. New York: Markel Dekker; 2002. p. 43–66.

    Google Scholar 

  67. Skassa-Brociek W, Manderscheid JC, Michel FB, Bousquet J. Skin test reactivity to histamine from infancy to old age. J Allergy Clin Immunol. 1987;80(5):711–6.

    Article  CAS  PubMed  Google Scholar 

  68. Weissenbacher S, Bacon T, Targett D, Behrendt H, Ring J, Darshow U. Atopy patch test- reproducibility and elicitation of itch in different application sites. Acta Derm Venereol. 2005;85:147–51.

    Article  PubMed  Google Scholar 

  69. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol. 2000;142:931–6.

    Article  CAS  PubMed  Google Scholar 

  70. Oranze AP, Devillers AC, Kunz B, Jones SL, DeRaeve L, Van Gysel D, de Waard-van der Spek FB, Grimalt R, Torrelo A, Stevens J, Harper J. Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel’s opinion and review of the literature. J Eur Acad Derm Venereol. 2006;20(10):1277–86.

    Article  Google Scholar 

  71. Reitamo S, Ortonne J-P, Sand C, Bos J, Cambazard F, Bieber T, Grønhøj-Larsen C, Rustin M, Folster-Hölst R, Schuttelaar M. Long term treatment with 0.1% tacrolimus ointment in adults with atopic dermatitis: results of a two-year, multicenter, non-comparative study. Acta Derm Venereol. 2007;87:406–12.

    Article  CAS  PubMed  Google Scholar 

  72. Thaci D, Chambers C, Sidhu M, Dorsch B, Ehlken B, Fuchs S. Twice-weekly treatment with tacrolimus 0.03% ointment in children with atopic dermatitis: clinical efficacy and economic impact over 12 months. J Eur Acad Dermatol Venereol. 2010;24:1040–6.

    CAS  PubMed  Google Scholar 

  73. Luger T, De Raeve L, Gelmetti C, Kakourou T, Kakourou T, Katsarou A, et al. Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis from medical needs to a new treatment algorithm. Eur J Dermatol. 2013;23(6):758–66.

    CAS  PubMed  Google Scholar 

  74. Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116–32.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Schmitt J, Schäkel K, Schmitt N, Meurer M. Systemic treatment of severe atopic eczema: a systematic review. Acta Derm Venereol. 2007;87:100–11.

    Article  CAS  PubMed  Google Scholar 

  76. Heil PM, Maurer D, Klein B, Hultsch T, Stingl G. Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical course a randomized, placebo-controlled and double blind pilot study. J Dtsch Dermatol Ges. 2010;8:990–8.

    PubMed  Google Scholar 

  77. Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014;371(2):130–9.

    Article  PubMed  Google Scholar 

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Katsarou, A., Armenaka, M.C., Zafiriou, E., Vakirlis, E. (2015). Atopic Dermatitis in the Aged. In: Farage, M., Miller, K., Maibach, H. (eds) Textbook of Aging Skin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27814-3_62-2

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