Silvestre Salvador J F, Romero-Pérez D, Encabo-Durán B
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain.
J Investig Allergol Clin Immunol. 2017;27(2):78-88. doi: 10.18176/jiaci.0138. Epub 2017 Jan 10.
Atopic dermatitis (AD) has a prevalence of 1%-3% in adults. Adult-onset AD has only been defined recently, and lack of familiarity with this condition and confusion regarding the appropriate terminology persist. AD may first appear in childhood or de novo in adults and is characterized by pronounced clinical heterogeneity. The disease often deviates from the classic pattern of flexural dermatitis, and there are forms of presentation that are specific to adults, such as head-and-neck dermatitis, chronic eczema of the hands, multiple areas of lichenification, or prurigo lesions. Although diagnosis is clinical, adult-onset AD frequently does not fit the traditional diagnostic criteria for the disease, which were developed for children. Thus, AD is often a diagnosis of exclusion, especially in de novo cases. Additional diagnostic tests, such as the patch test, prick test, skin biopsy, or blood test, are usually necessary to rule out other diseases or other types of eczema appearing concomitantly with AD. This article presents an update of the different forms of clinical presentation for AD in adults along with a proposed diagnostic approach, as new treatments will appear in the near future and many patients will not be able to benefit from them unless they are properly diagnosed.
特应性皮炎（AD）在成年人中的患病率为1%-3%。成人发病型特应性皮炎直到最近才被定义，目前人们对这种疾病仍缺乏了解，并且在合适的术语使用上存在混淆。AD可能在儿童期首次出现，也可能在成人中初发，其临床异质性显著。该疾病常常偏离经典的屈侧皮炎模式，存在一些特定于成人的表现形式，如头颈部皮炎、手部慢性湿疹、多处苔藓化或痒疹样皮损。尽管诊断主要依靠临床，但成人发病型AD常常不符合为儿童制定的该疾病传统诊断标准。因此，AD往往是一种排除性诊断，尤其是在初发病例中。通常需要进行额外的诊断测试，如斑贴试验、点刺试验、皮肤活检或血液检测，以排除其他疾病或与AD同时出现的其他类型湿疹。本文介绍了成人AD不同临床表现形式的最新情况以及一种建议的诊断方法，因为在不久的将来会出现新的治疗方法，除非得到正确诊断，否则许多患者将无法从中受益。
