Adult Atopic Dermatitis

The Eczema of the Grown Ups

Feb 20, 2009 Hanish Babu

Adult atopic dermatitis, the eczema of the grown ups, has specific features as compared to the infantile and childhood atopic eczema.

Around 20-40% of cases of childhood atopic eczema go into adolescent and adult atopic dermatitis. The adult atopic dermatitis has a similar distribution to the childhood atopic dermatitis with more pronounced thickening of the skin and increased skin markings.

Signs and Symptoms of Adult Atopic Dermatitis

The chronic eczema changes are more on the flexures and hands. In adolescents and young females, eczema of the nipples is common, with scaling, crusting, and, at times, acute exacerbation characterized by oozing and severe itching.

Lip borders show itchy skin rashes in many cases of adult atopic dermatitis. Hair follicle related thick bumps are seen in the black skinned and the Japanese.

Adult atopic eczema cases are more sensitive to sunlight, and may present with itchy skin rashes on the exposed areas like the face, outer forearms, neck etc.

Atopic hand eczema is a feature of both childhood atopic dermatitis and adult atopic dermatitis. The fingers and palms show crusty scales with fissures at places, which are very painful and often bleed following minor pressure. In adult eczema, the hand eczema is more thickened and lichenified.

Lichenification is the characteristic feature of chronic eczema, and includes thickening, increased skin markings and pigmentation of the involved skin. Lichenification is the result of constant scratching and rubbing of the skin. Half of the patients with hand eczema also have eczema of the feet.

Adult atopic dermatitis patients are more prone for occupational contact dermatitis than normal people.

The skin in adult atopic eczema patients is very dry. This could be due to loss of water through the epidermal cells which lose their coherence and barrier function in atopics; the dryness predisposes the skin to the itchy skin rash in atopic eczema.

Differential Diagnosis of Adult Atopic Eczema

• Scabies
• Contact Dermatitis
• Drug eruptions
• Seborrheic Dermatitis

Treatment of Adult Atopic Dermatitis

1. General advice and reassurance
2. Avoidance of triggering factors: soaps and detergents, food, airborne allergens, stress etc. Food hypersensitivity is less common in adult atopics than in infantile atopic dermatitis and childhood atopic dermatitis.
3. Topical therapy: Oatmeal baths and application of emollients to avoid dry skin. Adult atopic dermatitis with lichenification require ointments rather than creams or lotions.
4. Topical Corticosteroids: The strength, base and mode of application of topical steroids depend upon the severity of the dermatitis, the sites, and, of course the age of the patient. Least potency steroids should be used on the eyelids, face, the armpits, the groins and inner thighs. Depending upon the severity of the dermatitis, in adults, the treatment is started with potent strength steroids, then shifted to moderate potency later on. A general principle is to start with the higher strength topical steroid to control the dermatitis by twice daily application for 3-7 days, then to reduce the frequency of application or strength of the topical corticosteroids.
5. Once the thickness is reduced after steroid application, maintenance therapy with ichthammol and coal tar preparations may be considered.
6. Oral antihistamines to reduce the itching and antibiotics in the presence of superadded infection may be added

The management of atopic dermatitis in adults, as in children and infants, involves striking a balance between effective control of the dermatitis, improved quality of life and safe long term therapy.

Reference

• Atopic Dermatitis, in Rook’s Textbook of Dermatology, 7th Edition, 2004

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

The copyright of the article Adult Atopic Dermatitis in General Medicine is owned by Hanish Babu. Permission to republish Adult Atopic Dermatitis in print or online must be granted by the author in writing.

Adult Atopic dermatitis: Lichenification	Adult Atopic Dermatitis:Sub Acute Eczema	Adult Atopic Eczema: Flexure Dermatitis
Adult Eczema Nipple Dermatitis	Adult Eczema: Lip Dermatitis

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Comments

Jul 26, 2009 1:34 AM

Guest :

I have adult atopic dermatitis. I think it's really pathetic that the first thing on the list of treatment options is 'general advice and reassurance.' Those of us with adult AD are just as miserable as the children with AD, with the added stressors of family and work. And all that dermatologists can offer us is advice and reassurance and the same tired, old, and ineffective treatments that have been offered since 1960? Start researching, people, we're in pain out here!

Aug 25, 2009 7:55 AM

Guest :

AGREEEEEED!

Sep 3, 2009 4:13 AM

Guest :

very true- we need a cure

Sep 26, 2009 2:02 PM

Guest :

I agree completely! Just because this is some skin disease nobody considered valuable enough for serious research! WHY?? There is no even an explanation why do we have AD!

Oct 2, 2009 8:11 PM

Guest :

I agree with all the other comments. I am 31 years old and have been living with eczema since I was young. I have tried everything, and I'm so tired of dealing with this. I live in a beach town, and can't even go to the beach, because my legs look so horrible. I would like to be able to live my life and not always afraid of showing my legs. It's time for a cure!!!

Oct 10, 2009 1:17 AM

Guest :

I agree. i have had this condition since a child. i am now 44. in my younger days i was told i would grow out of it...i have grown into it. i could deal with it other then my hands...they are so itchy and painful and crack an bleed constantly. i have tried everything also and nothing works. you would think somewhere someone would have come up with something but i suppose its not high on the cure priority list. i understand that but still hope for some relief!

Jan 12, 2010 8:41 PM

Guest :

There is no mention of some basis creams that work: a combination of betamethasone, petrolatum and cliniderm cream work initially then the betamethasone can be taken away and the base works well. Also, Elidel cream works for maintenance. No hot water, soap, conditoner, wash hair separately, works well as well. The trick is to stop the irritation of skin!

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