Atopic Dermatitis in Adults

Reviewed by: HU Medical Review Board | June 2017

While most cases of atopic dermatitis (AD) begin in childhood, approximately 5% of cases begin in adulthood. Most children who have AD go into remission, but between 10% and 30% continue to have symptoms into adulthood. AD is caused by a combination of factors, including a genetic predisposition, environmental factors, a dysfunction in the immune system, and a dysfunction of the skin barrier.1-3

Symptoms of atopic dermatitis in adults

AD appears differently in infants, children and adults. In adults, AD frequently appears as a rash on the inner creases of the elbows or knees, and/or the nape of the neck, but it can occur anywhere. AD makes the skin dry, itchy, and scaly, and it may cause bumps.

AD ranges in severity from mild to severe and may cover large areas of the skin. Areas of skin where the AD rash occurs may get lighter or darker in color. Over time, the skin affected by AD can become thickened or leathery, also called lichenification. Lichenified skin may also develop knots. The lichenified skin is itchy all of the time, and proper treatment is important to reduce the development of permanently itchy, thickened skin patches.1,4

Triggers that can worsen AD include:

Complications of atopic dermatitis in adults

Some people develop complications from AD, including:

  • Infection: Because AD causes cracks and breaks in the skin and there is an immunologic dysfunction of the skin, there is a greater potential for infection
    In addition, the intense itching caused by AD leads to scratching, which also increases the risk of infection by bacteria, viruses, or fungi.1
  • Eye problems:Eye complications that may occur in people with AD include itching around the eyelids, eye watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).5
  • Sleep problems: Many people with AD wake repeatedly during the night to scratch due to the excessive itchiness. The repeated waking and loss of sleep is one of the most distressing impacts of AD.1,5
  • Psychological effects: Some people with AD experience poor self-esteem because of the social stigma of living with a chronic skin condition.5
  • Asthma and allergies: AD also puts a person at a higher risk of developing hay fever, or allergic rhinitis, and asthma.6
  • Contact dermatitis: Contact dermatitis is a separate skin condition, but some people with AD also develop it. Contact dermatitis occurs as a reaction when the skin comes in contact with a substance that is irritating, such as detergents, soaps, cleaners, or other chemicals.5

How to treat atopic dermatitis in adults

There is no known cure for atopic dermatitis (AD), but proper treatment can control the symptoms, including the itchiness, redness, inflammation, and dryness. Most patients with AD find that their symptoms improve with treatment, but as a chronic disease, AD can have a varying course.

A key part of treating AD is rehydrating the skin. Daily use of moisturizers is recommended, particularly after bathing or showering to lock in the moisture. Harsh soaps should be avoided. Mild soaps that are fragrance free and have a neutral or low pH are more gentle on the skin.7

Medications used to treat AD include:

  • Topical corticosteroids, to reduce redness, inflammation, and itching
  • Topical calcineurin inhibitors, to stop the dysfunctional immune response and reduce redness and itching
  • Immunosuppressants, which also target the dysfunctional immune response to reduce symptoms
  • Biologics, to block cellular pathways in the immune system that can lead to disease flares
  • Antibiotics, to fight infection
  • Antihistamines, to control itch8

Additional treatment options

  • Phototherapy, which uses ultraviolet light waves directed at the skin, is a second-line treatment strategy
  • Natural remedies, such as botanicals (from plants)
  • Dietary supplements, including one or a combination of vitamins, minerals, herbs, amino acids, metabolite, extract, or a substance to increase the total dietary intake

Other types of eczema

AD is the most common form of eczema. Other forms of eczema that occur in adults include:

Asteatotic eczema – Also called xerotic eczema, asteatotic eczema causes abnormally dry, itchy, and cracked skin. It often appears on the lower legs, thighs, chest, and arms. Asteatotic eczema is often experienced by elderly people, although it may also occur in people in their 20’s.9

Varicose eczema – Also called stasis eczema or gravitational eczema, it is particularly 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 and is common in people with varicose veins or chronic leg swelling.10

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