ADULT-ONSET ATOPIC DERMATITIS: CLINICAL CASE ANALYSIS WITH DIAGNOSTIC AND THERAPEUTIC INSIGHTS
Keywords:
Keywords: Adult-onset atopic dermatitis (AOAD), Diagnosis, Differential diagnosis, Clinical severity, Treatment strategiesAbstract
Introduction: Adult-onset atopic dermatitis (AOAD) is a distinct and increasingly recognized condition. This case report presents a patient with severe AOAD, both highlighting diagnostic and therapeutic challenges. Case Report: A 43-year-old male with extensive eczema and elevated IgE levels was treated with systemic corticosteroids, antihistamines, emollients, and phototherapy. Significant clinical improvement was noted. Conclusion: This case illustrates the complex management of AOAD and emphasizes the need for a multidisciplinary and personalized treatment approach.
Objective: This paper discusses a case of AOAD, providing clinical and diagnostic insights while integrating evidence from current literature.
Methods: A 43-year-old male with severe AOAD was evaluated using the Hanifin-Rajka criteria and the SCORAD index for diagnosis and severity assessment. Laboratory, histopathological, and allergological investigations supported the diagnosis. Relevant literature was reviewed to contextualize findings.
Results: The patient presented with extensive xerosis, erythema, and pruritus. Elevated serum IgE and eosinophilia confirmed a heightened atopic state. Management included systemic corticosteroids, antihistamines, emollients, and UVA phototherapy, resulting in symptom improvement. The case highlights the systemic and relapsing nature of AOAD, requiring a multidisciplinary approach.
Conclusion: AOAD differs significantly from COAD in pathogenesis, clinical features, and management. This case contributes to the growing body of literature on AOAD by showcasing its unique clinical features and the complexities associated with managing this under-recognized condition. Personalized, targeted therapies addressing skin barrier dysfunction, immune dysregulation, and systemic inflammation are essential to optimize outcomes.
References
Bannister MJ, Freeman S. Adult-onset atopic dermatitis. Australas J Dermatol. 2000;41(4):225–8. doi:10.1046/j.1440-0960.2000.00598.x
Maiello N, Comberiati P, Giannetti A, Ricci G, Carello R, Galli E. New directions in understanding atopic march starting from atopic dermatitis. Children (Basel). 2022;9(4):450. doi:10.3390/children9040450
Hill DA, Spergel JM. The atopic march: Critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018;120(2):131–7. doi:10.1016/j.anai.2017.06.001
Son JH, Chung BY, Kim HO, Park CW. Clinical features of atopic dermatitis in adults are different according to onset. J Korean Med Sci. 2017;32(8):1360–6. doi:10.3346/jkms.2017.32.8.1360
Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980;92:44–7.
Rönmark EP, Ekerljung L, Mincheva R, et al. Different risk factor patterns for adult asthma, rhinitis and eczema: results from West Sweden Asthma Study. Clin Transl Allergy. 2016;6:28. doi:10.1186/s13601-016-0112-0
Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91–101. doi:10.1016/j.jaip.2019.06.044
Alakeel A, Al Sheikh A, Alraddadi AA, et al. Management of atopic dermatitis in adults in Saudi Arabia: consensus recommendations from the dermatological expert group. Clin Cosmet Investig Dermatol. 2022;15:1435–45. doi:10.2147/CCID.S376345