Adult-Onset Atopic Dermatitis

  • Jonathan I. Silverberg
    Corresponding author: Jonathan I. Silverberg, MD, PhD, MPH, Department of Dermatology, Northwestern University Feinberg School of Medicine, Ste 1600, 676 N St Clair St, Chicago, IL 60611.
    Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Ill

    Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Ill
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      One in 4 adults with atopic dermatitis (AD) report adult-onset disease. Adult-onset AD appears to be associated with a different disease phenotype compared with childhood-onset AD. A broad differential diagnosis must be considered in a patient presenting with an adult-onset eczematous eruption, including allergic contact dermatitis, mycosis fungoides/cutaneous T-cell lymphoma, psoriasis, scabies, and so forth. This review will specifically address the diagnosis, workup, and management of adult-onset AD. In adults presenting a new-onset chronic eczematous eruption, consideration should be given to a diagnosis of adult-onset AD. Patch testing should be performed to rule out allergic contact dermatitis. A biopsy may be obtained to exclude alternative diagnoses, including cutaneous T-cell lymphoma and psoriasis.

      Key words

      Abbreviations used:

      ACD (allergic contact dermatitis), AD (atopic dermatitis), CTCL (cutaneous T-cell lymphoma), H-R (Hanifin and Rajka), SPT (skin prick test)
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      1. Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis [published online ahead of print June 1, 2018]. J Am Acad Dermatol.

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