Clinical Manifestations of Atopic Dermatitis


Diego Ruiz Dasilva, MD, FAAD, reviews the difference between clinical presentation of atopic dermatitis in adults vs children, as well as the pathophysiology of the disease.

Diego Ruiz Dasilva, MD, FAAD: Atopic dermatitis [AD] is an inflammatory skin disorder with complex intertwining. Etiologies present with really itchy skin as the hallmark. But the rash itself can be variable from each patient presenting with little bumps—we call them papules—large patches; plaques; excoriations or itch marks; lichenifications, which is thickened skin; or really dry skin. Eczema is synonymous with dermatitis. People use those terms interchangeably. It’s a broad term that describes skin inflammation that encompasses numerous conditions. AD is a type of eczema. However, both laypeople and clinicians use these terms interchangeably. Typical onset is by 5 years old, and it affects up to 25% of children. In recent times, we’re starting to see the disease prevalent in adulthood as well.

Many of these patients may not have had eczema as children, but it can happen that way. Many children grow out of it by adulthood, but it’s more that their severity and clinical presentation soften, so it’s less bothersome. But it’s still a chronic disease with a waxing and waning course throughout life, although sometimes remission can last many years.

There are differences in typical eczema and adult eczema in that children tend to be affected in more classic areas, like elbows, knees, wrists, and cheeks, depending on the age group; adults have a random pattern of affected skin. Children also tend to have classic red excoriated patches, while adults tend to have variable morphology. In terms of pathophysiology, adult AD tends to stem more from immune senescence or immune aging. Poor skin barrier is coupled with age-related degradation of the skin barrier. It’s not completely worked out, but much basic scientific research still goes into AD, despite it being such a prominent, well-known, long-standing disease.

Transcript edited for clarity

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