164 Changes in the geographic distribution of atopic dermatitis on the body with age

Phenotypic differences of atopic dermatitis stratified by age

Background

Atopic dermatitis (AD) is common across all ages. Understanding heterogeneous age-related phenotypes may improve AD management.

Objective

To determine age-related clinical phenotypes of AD.

Methods

A prospective, dermatology practice-based study was performed (n = 380). AD severity was evaluated using questionnaires and full-body examination. Phenotypes were determined using latent class analysis.

Results

There were 23 (6.1%) pediatric patients (<18 years), 176 (46.3%) young adults (18-39 years), and 181 (47.6%) older adults (≥ 40 years). Both young and older adults experienced less AD on ankles (adjusted odds ratio [95% confidence interval]: 0.41 [0.19-0.90], 0.43 [0.20-0.94]), moderate-severe AD on flexures (0.47 [0.26-0.87], 0.30 [0.16-0.56]), pityriasis alba (0.24 [0.11-0.52], 0.07 [0.03-0.18]), oozing lesions (0.44 [0.25-0.79], 0.35 [0.20-0.63]), moderate-severe excoriations (0.49 [0.28-0.85], 0.44 [0.26-0.76]), and severe itch (adjusted β [95% confidence interval], -1.46 [-2.63 to -0.29]; -1.79 [-2.94 to -0.65]) compared with pediatric patients. Young adults experienced more AD around the eyes (2.92 [1.21-7.02]). Older adults experienced more AD on elbows (0.34 [0.19-0.64]), nipples (0.40 [0.16-0.99]), knees (0.27 [0.14-0.53]), keratosis pilaris (0.38 [0.15-0.98]), and lichenification (0.47 [0.22-0.98]). Four classes were identified for distribution of AD and associated signs.

Conclusion

Distinct phenotypes exist by age with younger patients experiencing more AD signs and symptoms. Clinicians should consider them when managing AD.

A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics

BACKGROUND

Previous studies found conflicting results about the commonality of different atopic dermatitis (AD) signs and symptoms.

OBJECTIVE

To determine the prevalences of AD characteristics and differences by region and age.

METHODS

A systematic review was performed of all published studies in MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii that analyzed the proportion of AD characteristics. Two reviewers performed a review study titles and/or abstracts and data abstraction.

RESULTS

In all, 101 studies reported proportion of AD features with sufficient data for meta-analysis. The most prevalent AD features were pruritus, lichenification, and xerosis. There were differences in AD characteristics by study region. Flexural involvement was less commonly reported in India, the Americas, and Iran. Studies from East Asian reported more erythroderma and truncal, extensor, scalp, and auricular involvement. Studies from Southeast Asia reported more exudative eczema, truncal involvement, lichenification, and prurigo nodularis. Studies from Iran reported more head, face, and neck involvement; pityriasis alba; and xerosis. Studies from Africa reported more papular lichenoid lesions, palmar hyperlinearity, ichthyosis, and orbital darkening.

LIMITATIONS

Heterogeneity between studies and limited reporting of certain AD clinical characteristics.

CONCLUSIONS

AD characteristics are heterogeneous and vary by region and age.