Dermatologic Clinic, Sapienza University of Rome, Rome, Italy.
Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy.
Int J Dermatol. 2020 Jun;59(6):716-721. doi: 10.1111/ijd.14891. Epub 2020 Apr 20.
Atopic dermatitis (AD) is a chronic relapsing eczematous dermatitis typically affecting young patients in a percentage from 15 to 20%; although it typically affects young people and adults, recent papers highlighted the emerging of the disease in the elderly population.
The aim of the study was to identify the clinical criteria and allergic sensitization that may be able to support physicians and dermatologists in making a correct diagnosis of AD in the elderly. The second aim of this study was to investigate the incidence, the main features, the gender prevalence, the immunological profile, and comorbidities characterizing patients older than 65 years affected by AD.
Based on clinical and serological patterns, different phenotypes of AD were identified: generalized AD (55%) characterized by eczematous lesions involving typical areas of the body or prurigo nodularis-like AD; chronic eczematous hand dermatitis (23%); face and neck involvement (9%); and nummular eczema (13%). Skin prick tests revealed a positivity for aeroallergens in 49.6% of patients, most of them being polysensitized (55%). Additionally, food skin prick tests were positive in 25% of patients. Most of the patients reported comorbidities, particularly IgE-mediated diseases, such as seasonal rhino-conjunctivitis, asthma, and chronic obstructive pulmonary disease. Gastrointestinal symptoms such as meteorism, dyspepsia, cramps/abdominal pain, and diarrhea/constipation, were observed in 35% of patients consequent to food allergy.
In our study, we suggest clinical and serological criteria that may be able to guide in the diagnosis of AD in Caucasian elderly, and to design an appropriate treatment according to the current standard protocol.
特应性皮炎（AD）是一种慢性复发性湿疹性皮炎，通常影响 15%至 20%的年轻患者；尽管它通常影响年轻人和成年人，但最近的论文强调了该疾病在老年人群中的出现。
本研究旨在确定临床标准和过敏致敏，以帮助医生和皮肤科医生正确诊断老年人的 AD。本研究的第二个目的是调查发病率、主要特征、性别患病率、免疫特征和伴有 65 岁以上 AD 患者的共病。
根据临床和血清学模式，确定了不同表型的 AD：全身性 AD（55%），其特征为累及典型身体区域或痒疹样 AD 的湿疹病变；慢性湿疹性手部皮炎（23%）；面部和颈部受累（9%）；和钱币状湿疹（13%）。皮肤点刺试验显示 49.6%的患者对气传过敏原呈阳性，其中大多数为多敏性（55%）。此外，25%的患者食物皮肤点刺试验呈阳性。大多数患者报告有共病，特别是 IgE 介导的疾病，如季节性鼻结膜炎、哮喘和慢性阻塞性肺疾病。胃肠道症状，如气胀、消化不良、痉挛/腹痛和腹泻/便秘，在 35%的因食物过敏的患者中观察到。
在我们的研究中，我们提出了临床和血清学标准，这些标准可能有助于指导高加索老年人 AD 的诊断，并根据当前的标准方案设计适当的治疗方案。
