Tips for Treating Atopic Dermatitis Part 2

Dr. Lugo-Somolinos

Aida Lugo-Somolinos, MD, shares her approach to diagnosing and treating adult atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by itching and the presence of eczematous plaques in symmetrical distribution. It usually appears in childhood and tends to disappear in adolescence but 10% to 30% of cases may persist into adulthood.1

The diagnosis and management of patients with AD whose disease persists into adulthood poses the same challenges as treating AD in younger ages. The real challenge in diagnosis is when an adult patient presents with a dermatitis “de novo.”

Although adult-onset AD has been described in the literature, I try to make sure it fits some diagnostic criteria and exclude other possible conditions. Therefore, I suggest clinicians:

  1. Review the Hanifin and Rajka criteria.2,3 Does the patient have a personal history of asthma or allergic rhinitis? Does he/she have dry skin?
  2. Look at all the affected skin. Some locations can give you clues for considering AD more than others. Are the nipples affected in females? Are hands affected but not feet? Is scalp normal? Is the dermatitis symmetrical?
  3. If the dermatitis is generalized or does not have a symmetrical pattern consider biopsy, skin scrapping for scabies, and patch testing. Biopsy will help you rule out serious conditions like cutaneous t cell lymphoma or erythrodermic psoriasis. Patch testing will help you in determining if your patient has an allergic contact dermatitis that is the etiology of the dermatitis or if it is a contributing factor of an underlying AD that you cannot recognize clinically.

Once I exclude all other possible diagnoses then I proceed to treat as AD.

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