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Atopic dermatitis in adults: a diagnostic challenge

Silvestre Salvador JF, Romero-Pérez D, Encabo-Durán B

Servicio de Dermatología, Hospital General Universitario de Alicante

J Investig Allergol Clin Immunol 2017; Vol. 27(2)
doi: 10.18176/jiaci.0138

Atopic dermatitis (AD) has a prevalence of 1-3% in adults. Adult-onset AD has only been defined recently, and lack of familiarity with it and confusion regarding the terminology still persist. AD may first appear in childhood or de novo in adults, and it is characterised by pronounced clinical heterogeneity. It often deviates from the classic pattern of flexural dermatitis, and there are forms of presentation that are specific to adults, such as head-and-neck dermatitis, chronic eczema of the hands, multiple areas of lichenification or prurigo lesions. Although diagnosis is clinical, adult-onset AD frequently does not fit the traditional diagnostic criteria for the disease, which were developed for children. Thus, AD is often a diagnosis of exclusion, especially in de novo cases. Additional diagnostic tests, such as the patch test, prick test, skin biopsy or blood test, are usually necessary to rule out other diseases or other types of eczema appearing concomitantly with AD. This article presents an update of the different forms of clinical presentation for AD in adults along with a proposal for diagnostic approach, as new treatments will appear in the near future, and many of these patients will not be able to benefit from them unless they are properly diagnosed.

Key words: Atopic dermatitis, Adult, Diagnosis, Patch testing, Prick testing