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  • Presentation

Atopic Dermatitis in Adults: Not Just Big Kids

Description

Dr. Jonathan Silverberg presents on atopic dermatitis (AD) in adults, emphasizing important clinical distinctions from pediatric cases. He discusses prevalence rates, revealing that about 7% of adults in the U.S. are affected, challenging the belief that AD typically fades after childhood. Silverberg highlights differences in disease manifestation, with adults often experiencing more severe chronic symptoms, as well as the lack of awareness regarding adult-onset cases (26% of adult patients). He stresses the importance of individualized treatment plans that consider patient goals, preferences, and comorbidities, including anxiety, depression, and sleep issues. Recent treatment advancements including biologics (e.g., dupilumab, lebrikizumab) and JAK inhibitors (e.g., abrocitinib, upadacitinib) are showcased, noting their efficacy across various demographics with specific attention to rapid response rates in severe cases. The session also emphasizes that while shared decision-making is crucial, there’s a need for clinical discretion based on the patient’s situation. Silverberg concludes with a call for ongoing research into the efficacy of therapies across different patient populations, especially considering their unique responses to treatment.

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Conclusions

  • Atopic dermatitis (AD) in adults is prevalent, with studies showing about 7.2% of adults in the US affected.
  • The belief that AD is primarily a childhood disease is a misconception, as many adults experience onset or recurrence of the disease later in life.
  • Around 26% of AD cases in adults are reported to have adult-onset disease, challenging the idea that it only persists from childhood.
  • The severity of AD tends to be higher in adults compared to children, particularly in terms of chronic disease manifestation and persistence.
  • Persistent AD cases often correlate with factors such as disease severity and duration, with longer history associated with lower clearance rates.
  • Different age groups show varied patterns of incidence and persistence for AD, with childhood and adult onset presenting unique clinical characteristics.
  • There appear to be differences in the underlying mechanisms of AD between children and adults, which may influence treatment responses and strategies.
  • Comorbidities associated with AD include asthma, allergies, and mental health issues, indicating that AD is part of a broader atopic diathesis.
  • New therapies for AD are emerging, with different mechanisms of action and promising efficacy, highlighting the importance of personalized treatment approaches.
  • Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Simpson EL, Ong PY, Chiesa Fuxench ZC. Patient-burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Annals of Allergy, Asthma and Immunology. 2018. 121(3):340-347.
  • Hua T, Silverberg JI. Atopic dermatitis in US adults - epidemiology, association with marital status and atopy. Annals of Allergy, Asthma and Immunology. 2018. 121(5):622-624.
  • Silverberg JI. Public Health Burden and Epidemiology of Atopic Dermatitis. Dermatol Clin. 2017 Jul;35(3):283-289.
  • Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol. 2018 Jun 1. pii: S0190-9622(18)32046-2. doi: 10.1016/j.jaad.2018.05.1241.
  • Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis: A systematic review and meta-analysis. J Amer Acad Derm. 2016 Oct;75(4):681-687.
  • Roduit C, Frei R, Depner M, Karvonen AM, Renz H, Braun-Fahrländer C, Schmausser-Hechfellner E, Pekkanen J, Riedler J, Dalphin JC, von Mutius E, Lauener RP; and the PASTURE study group, Hyvärinen A, Kirjavainen P, Remes S, Roponen M, Dalphin ML, Kaulek V, Ege M, Genuneit J, Illi S, Kabesch M, Schaub B, Pfefferle PI, Doekes G. Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. 2017 Jul 1;171(7):655-662.
  • Margolis DJ, Apter AJ, Gupta J, Hoffstad O, Papadopoulos M, Campbell LE, Sandilands A, McLean WH, Rebbeck TR, Mitra N. The persistence of atopic dermatitis and filaggrin (FLG) mutations in a US longitudinal cohort. J Allergy Clin Immunol. 2012 Oct;130(4):912-7.
  • Margolis DJ, Kim B, Apter AJ, Gupta J, Hoffstad O, Papadopoulos M, Mitra N. Thymic stromal lymphopoietin variation, filaggrin loss of function, and the persistence of atopic dermatitis. JAMA Dermatol. 2014 Mar;150(3):254-9.
  • Zhou L, et al. Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis. JACI. 2019; 144(1): 144-156.
  • Chiesa Fuxench ZC, Boguniewicz M, Fonacier L, Gelfand JM, Grayson MM, Margolis DJ, Ong P, Schwartz LB, Silverberg J, Simpson E. [6236] Prevalence and Impact of Disease Severity on Health Related Quality of Life in Adult Patients with Atopic Dermatitis. AAD 2018 Annual Meeting.