A doctor checks out the arm of an adult eczema patient.

Is It Adult-Onset Atopic Dermatitis or Something Else?

Any kind of itchy, red rash is bothersome. The longer the rash lasts, the more anxiety it brings. Not knowing the cause of the symptoms only adds to the worry. A diagnosis can help explain things and lessen some concerns. But pinpointing adult-onset atopic dermatitis (AD) is seldom easy.

What is atopic dermatitis?

Atopic dermatitis or eczema is a chronic condition with itching, inflammation, and redness of the skin. The definition of atopic dermatitis varies. A group of doctors who looked at 45 studies found 59 definitions of AD. They also found that using different meanings affected estimated rates of atopic dermatitis prevalence.2

Adult-onset atopic dermatitis

Atopic dermatitis usually starts in childhood and can continue into adulthood. In some people, AD begins after age 18. This is known as adult-onset atopic dermatitis. Doctors first used this term in 2000.1

Poll

When did you begin experiencing atopic dermatitis symptoms?

How many people have adult-onset atopic dermatitis?

A study printed in 2018 projected that 16.5 million adults in America have AD.3 Adult-onset atopic dermatitis affects 25 percent of adults with atopic dermatitis.4

How is adult-onset atopic dermatitis different?

Adult-onset atopic dermatitis differs in some ways from AD that starts in childhood. People with adult-onset atopic dermatitis are less likely to have facial rashes and pink eye. They also have little or no history of atopic or allergic diseases.4 The form and extent of the rash in adults with atopic dermatitis differ from that in children. Adults with AD tend to have a rash only in certain areas. They typically have thickened skin and more growths and markings on their skin.5

How is it diagnosed?

Doctors use a physical exam and lots of questions to diagnose adult-onset atopic dermatitis. They will ask a patient about their symptoms and medical history.2,4

The Hanifin and Rajka (H-R) criteria

The Hanifin and Rajka (H-R) criteria are generally used for diagnosing atopic dermatitis. These measures are not specific to adult-onset AD. But they help diagnose atopic dermatitis in adults as well as children.1,4,6 The H-R criteria include major and minor categories. At least 3 of the criteria in each category are needed to make a diagnosis.6

Major criteria to diagnose atopic dermatitis

Major criteria include dermatitis, itching, and the form and location of the rash. Common rash sites to look for in children are the arms, face, and behind the knees. In adults, a factor is thick, leathery skin where the joints bend. 6 A history of atopic diseases is also among the major criteria. The patient or their family member(s) may have had allergic rhinitis, asthma, and/or atopic dermatitis.6

Minor criteria to diagnose atopic dermatitis

The minor category has more than 20 criteria. These range from nonallergic hand dermatitis and pink eye to intolerance of food and wool. A common minor measure is a high level of immunoglobulin antibodies produced in response to allergens.6

Ruling out other conditions

Ruling out conditions that mirror atopic dermatitis helps doctors diagnose adult-onset atopic dermatitis. But even this is hard. A person may have AD and a condition like allergic contact dermatitis all at once.4

What conditions look like atopic dermatitis?

A lot of conditions that affect the skin can look like atopic dermatitis. The most common ones are allergic contact dermatitis, psoriasis, and T-cell lymphoma. Others are autoimmune diseases, drug reactions, fungal infections, and immunodeficiency syndromes.

How can we tell the difference?

Although a test does not exist for AD, there are tests for other skin conditions. Doctors can use patch tests to detect allergic contact dermatitis. A biopsy shows psoriasis and forms of T-cell lymphoma and lupus that affect the skin.2,4

Treatment and lifestyle modifications

There is hope for people diagnosed with adult-onset atopic dermatitis. A correct diagnosis can lead to the right medical care. Drugs and moisturizers are often used to treat AD. The most common drugs are corticosteroids, which reduce inflammation, itching, and redness. Avoiding certain foods, stress, and other things that lead to symptoms can also help.1

If you think you have adult-onset atopic dermatitis, talk to your doctor. He or she can make a diagnosis. They can also advise you on the best course of treatment.

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