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  • Presentation

Atopic Dermatitis in Adults: Not Just Big Kids

Description

In a comprehensive talk on atopic dermatitis (AD) in adults, Professor Jonathan Sober, an expert in dermatology, discusses the complexities of diagnosing and managing this condition, which is often mistaken for other skin ailments. He emphasizes that much of the educational material has historically focused on pediatric presentations, leading to misconceptions about adult cases. Sober highlights the uniqueness of adult AD, noting differences in lesion presentation and experience between children and adults, as well as the importance of recognizing variability in symptoms, which often leads practitioners to miss severe cases.



He outlines the importance of using clinical assessments and patient-reported outcomes to better understand the severity of the disease and improve treatment decisions, advocating for shared decision-making with patients. Sober discusses various treatment options, including topical steroids, new biologics, and targeted therapies, stressing the need for thorough patient evaluations to avoid oversights in diagnosis and treatment effectiveness. Furthermore, he addresses the potential risks associated with some medications, the question of safety in older adults, and the significance of patient preferences in treatment choices. The session culminates with a call to action for the dermatology community to integrate patient perspectives and standardized assessment tools in managing AD more effectively.

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Conclusions

  • Atopic dermatitis (AD) in adults often presents differently than in children, highlighting the need for age-specific approaches to treatment.
  • There is significant heterogeneity in the clinical manifestations of AD, indicating varying underlying pathophysiological mechanisms between pediatric and adult populations.
  • Adult patients with AD frequently experience more chronic and less inflamed skin lesions compared to children, which complicates diagnosis and treatment.
  • The majority of adults with atopic dermatitis will have persistent symptoms that likely require ongoing management rather than a one-time treatment approach.
  • In adults, hand eczema is common and may be underrecognized in patients with a history of atopic dermatitis, necessitating appropriate diagnostic workflows and patch testing when indicated.
  • Treatment strategies should incorporate shared decision-making principles to involve patients in their care plans actively, tailoring therapies to individual needs and expectations.
  • Emerging therapies, including biologics and Janus kinase inhibitors, show promise for treating adult atopic dermatitis, but careful monitoring for potential side effects is essential.
  • Guidelines recommend patch testing for adult-onset atopic dermatitis when differentiating from contact dermatitis, emphasizing the need for accurate and thorough evaluations.
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  • Silverberg JI, et al. J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1306-1312.
  • Yew YW, Thyssen JP, Silverberg JI. J Am Acad Dermatol. 2019 Feb;80(2):390-401.
  • Silverberg, J. I. et al. Distribution of atopic dermatitis lesions in United States adults. J. Eur. Acad. Dermatology Venereol. 33, 1341-1348 (2019).
  • Silverberg JI, Warshaw EM, Atwater AR, Maibach HI, Zug KA, Reeder MJ, Sasseville D, Taylor JS, Fowler JF Jr, Pratt MD, Fransway AF, Zirwas MJ, Belsito DV, Marks JG Jr, DeLeo VA, DeKoven JG. Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016. J Am Acad Dermatol. 2021 Apr;84(4):989-999.
  • Silverberg JI, Patel N, Warshaw EM, DeKoven JG, Belsito DV, Atwater AR, Houle MC, Taylor JS, Reeder MJ, Zug KA, Sasseville D, DeLeo VA, Pratt MD, Fowler JF Jr, Maibach HI. Hand and foot dermatitis in patients referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2001-2018. J Am Acad Dermatol. 2022 Nov;87(5):1049-1059.