Atopic Dermatitis in Older Adults

Doctors are starting to diagnose more people with atopic dermatitis (AD) after age 60, especially in industrialized countries.1 Atopic dermatitis is on the rise across all age groups, but is still not very common among older adults. Just 1 to 3 percent of the population of industrialized countries have atopic dermatitis.2

How many people had eczema at a younger age?

According to recent research, about 30 percent of people in their 60s with atopic dermatitis say they had never experienced the condition before. Another 20 percent had atopic dermatitis in childhood. The remaining 50 percent say it started during early adulthood.1

Symptoms vary by age

Depending on your age, atopic dermatitis can show up with different symptoms and appear on different parts of your body. About 90 percent of AD cases occur among babies and children. Among those, many outgrow the condition by the time they become young adults.3

What are the symptoms?

Symptoms of AD include itchy red skin as well as patches that are dry and scaly and may ooze, crust and thicken over time. Atopic dermatitis does not go away quickly (it is known as a chronic disease). It goes through phases of being more or less severe. Periods, when AD gets worse, are called “flares.”

Symptoms in babies and children

For babies and young children, atopic dermatitis usually starts as a sudden rash on the face, elbows, or knees. The skin may bubble, ooze, and become crusty. In older children, AD often appears in the inner folds of the knees, elbows, or wrists. It may also be present on the scalp or behind the ears.4

Symptoms in adults

In adults, the skin affected by atopic dermatitis tends to be dry, patchy, scaly, and often discolored. AD patches in adults might occur in different places than in children. It can be under the eyes, for example, and on the back of the knees, the crook of the elbows, back of the neck, and on the face.5

Symptoms in older adults

When atopic dermatitis develops in seniors, it generally appears as a red rash in patches on the face, neck, and trunk. Unlike in children and younger adults, AD in seniors may not be seen in the crooks of the elbows, knees, and wrists. The skin may appear thicker, but less often in the places typical of children and adults.2

Who's more likely to develop eczema later in life?

Men are two times more likely than women to develop AD later in life. Unlike forms of AD that go away over time, most people who get AD in their 60s do not clear the disease.2

Are allergies and asthma common for older adults?

Similar to AD that begins at younger ages, seniors with AD also often experience asthma and other allergies. About 70 percent to 80 percent of older adults with AD also show high sensitivity to allergens, especially dust mites and pollen.2

Ruling out lymphoma

If you are 60 or older and have skin symptoms of atopic dermatitis, your doctor may order a biopsy to test for cutaneous T-cell lymphoma (CTCL). This is a form of cancer whose symptoms can look similar to very-late-onset atopic dermatitis. The key difference is that CTCL does not itch, whereas AD tends to be very itchy.1

Causes

Atopic dermatitis is a relatively common skin condition. More than 18 million Americans have it. The exact cause is not totally known, but a combination of genetic and environmental factors seems to play a role. Families, where people have AD, are also prone to asthma and hay fever.3

Triggers

AD can be triggered by other factors, including:6

  • Exposure to harsh soaps or fragrances
  • Dry skin
  • Certain metals, particularly nickel
  • Certain chemicals
  • Various medications
  • Stress
  • Sweating
  • Hormones
  • Exposure to allergens, like dust, pollen, and food

Treatments for older adults

As with adult AD, treatment for older people with AD focuses on:1

  • Protecting the skin from dryness with lotions and creams
  • Using anti-inflammatory medicines, including cream-based corticosteroids, cream-based calcineurin inhibitors, and oral antihistamines
  • Recognizing and avoiding triggers from the environment, like allergens or other chemicals

In moderate or severe cases of atopic dermatitis in older adults, treatment often does not respond to medicated lotions or creams. Instead, strong anti-inflammatory steroid drugs taken by mouth may be needed.2

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Sara Finkelstein | November 2019