Atopic Dermatitis in Adults and the Elderly

While most cases of atopic dermatitis (also known as eczema) begin in childhood, about 1 in 4 people develop the condition in adulthood. This is called adult-onset atopic dermatitis. Also, most children who have eczema go into remission. But some of them continue to have symptoms into adulthood.¹

Both adult and childhood eczema have become more common in recent decades. Women have been found to be more prone to adult eczema than men. Eczema may be caused by a combination of factors, including:^1-3

• Family history and genetics
• Environmental factors
• Immune system problems

Symptoms of eczema in adults and the elderly

Eczema appears differently in adults than in infants and children. Atopic dermatitis in adults can appear anywhere on the body, but it often appears:^3,4

• On the inner creases of the elbows or knees
• The nape of the neck
• Around the eyes

Eczema makes the skin dry, itchy, and scaly, and it may cause bumps. Areas of skin where the eczema rash occurs may get lighter or darker in color. Eczema ranges in severity from mild to severe and may cover large areas of the skin.^3,4

Over time, the skin affected by eczema can become thickened or leathery. This is called lichenification. Lichenified skin may also develop knots. The lichenified skin is itchy all the time. Proper treatment is important to reduce the development of permanently itchy, thickened skin patches.⁴

Eczema triggers

Triggers that can worsen eczema symptoms include:²

• Dry skin
• Irritants, such as harsh soaps, certain fabrics, fragrances, or dust
• Stress
• Extreme heat or extreme cold
• Allergens, including some foods, pet dander, dust mites, molds, or pollens
• Sweat

Possible eczema complications in adults and the elderly

Complications can sometimes arise in adults with eczema. For example:^1-3

• Infection – Because eczema causes cracks and breaks in the skin, there is a greater chance of infection. Also, frequent scratching increases the risk of infection by bacteria, viruses, or fungi.
• Eye problems – Eye complications may include itching around the eyelids, eye-watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).
• Sleep problems – Due to extreme itchiness, many people with eczema wake repeatedly during the night to scratch. The resulting loss of sleep can be a distressing side effect of eczema.
• Asthma and allergies – Eczema also puts people at higher risk for developing hay fever, allergic rhinitis, and asthma.
• Contact dermatitis – Contact dermatitis is a separate skin condition, but many people with eczema develop it. Contact dermatitis occurs when the skin comes in contact with an irritating substance. This may be a detergent, soap, cleaner, or other chemical.
• Poor mental health and self-image – Adults with eczema are 2 to 3 times more likely to have anxiety and depression. Eczema can affect self-esteem because of the social stigma of living with a chronic skin condition.

Eczema treatment for adults and the elderly

There is no known cure for atopic dermatitis. But proper treatment can help control symptoms. Most people with eczema find that their symptoms improve with treatment. Because it is a chronic disease, eczema may come and go. Its severity varies from person to person.^2,5

Adult eczema treatment comes down to 3 main approaches:^2,5

• Moisturizing and rehydrating the skin
• Adopting healthy lifestyle habits
• Taking medicine as needed

Moisturizing regularly

A key part of treating eczema is rehydrating the skin. Daily use of moisturizers is recommended, particularly after bathing or showering. This helps lock in moisture. Avoid harsh soaps. Mild soaps that are fragrance-free and have a neutral or low pH are more gentle on the skin.^2,5

Healthy lifestyle habits

Experts recommend the following lifestyle habits to help reduce symptoms and flare-ups:^2,5

• Steer clear of known triggers
• Try to reduce stress
• Eat a healthy diet
• Get enough sleep

Medicines to treat eczema

If moisturizing and lifestyle changes are not enough to treat eczema symptoms, there are many over-the-counter (OTC) and prescription medicines available. Talk to your dermatologist about the best treatment for you. Medicines for eczema include:^2,3,5

• Topical corticosteroids – can reduce redness, inflammation, and itching
• Topical calcineurin inhibitors – block the dysfunctional immune response to reduce redness and itching
• Immunosuppressants – target the dysfunctional immune response to reduce symptoms
• Biologics – block processes in the immune system that can lead to disease flares
• Antibiotics – fight infection
• Antihistamines – help control itch

Other types of eczema in adults and the elderly

Atopic dermatitis is the most common form of eczema. But other forms of eczema can occur in adults, like:^6,7

• Asteatotic eczema – Also called xerotic eczema, this causes abnormally dry, itchy, and cracked skin. It often appears on the lower legs, thighs, chest, and arms. Asteatotic eczema is often experienced by older people, although it may also occur in people in their 20s.
• Varicose eczema – Also called stasis eczema or gravitational eczema, this is especially common in women. Like other forms of eczema, it can cause the skin to become itchy, red, dry, or scaly. Varicose eczema affects the lower legs. It is common in people with varicose veins or chronic leg swelling.

Be aware of eczema mimickers

There are some health conditions that may look like eczema but are something entirely different. Cutaneous T cell lymphoma (CTCL) is a rare type of blood cancer that affects the skin. It happens when certain white blood cells, called T cells, become cancerous and gather in the skin, causing red, scaly patches that may itch.⁸

Because these symptoms can look a lot like adult eczema, CTCL can sometimes be mistaken for it. But CTCL does not improve with typical eczema treatments and may worsen over time. If your skin symptoms do not improve with treatment, your doctor might suggest a skin biopsy to check for CTCL.⁸