Chatrath Sheena, Silverberg Jonathan I
Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.
JAAD Int. 2022 Oct 10;11:1-7. doi: 10.1016/j.jdin.2022.08.026. eCollection 2023 Jun.
Atopic dermatitis (AD) is common across all ages. Understanding heterogeneous age-related phenotypes may improve AD management.
To determine age-related clinical phenotypes of AD.
A prospective, dermatology practice-based study was performed ( = 380). AD severity was evaluated using questionnaires and full-body examination. Phenotypes were determined using latent class analysis.
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.
Distinct phenotypes exist by age with younger patients experiencing more AD signs and symptoms. Clinicians should consider them when managing AD.
特应性皮炎（AD）在各年龄段均很常见。了解与年龄相关的异质性表型可能会改善AD的管理。
确定AD与年龄相关的临床表型。
进行了一项基于皮肤科实践的前瞻性研究（n = 380）。使用问卷和全身检查评估AD严重程度。使用潜在类别分析确定表型。
有23名（6.1%）儿科患者（<18岁），176名（46.3%）年轻人（18 - 39岁），以及181名（47.6%）老年人（≥40岁）。与儿科患者相比，年轻人和老年人在脚踝处的AD发生率较低（调整后的优势比[95%置信区间]：0.41[0.19 - 0.90]，0.43[0.20 - 0.94]），屈侧中度至重度AD发生率较低（0.47[0.26 - 0.87]，0.30[0.16 - 0.56]），白色糠疹发生率较低（0.24[0.11 - 0.52]，0.07[0.03 - 0.18]），渗出性皮损发生率较低（0.44[0.25 - 0.79]，0.35[0.20 - 0.63]），中度至重度抓痕发生率较低（0.49[0.28 - 0.85]，0.44[0.26 - 0.76]），以及严重瘙痒发生率较低（调整后的β[95%置信区间]，-1.46[-2.63至-0.29]；-1.79[-2.94至-0.65]）。年轻人在眼睛周围的AD发生率较高（2.92[1.21 - 7.02]）。老年人在肘部（0.34[0.19 - 0.64]）、乳头（0.40[0.16 - 0.99]）、膝盖（0.27[0.14 - 0.53]）、毛发角化病（0.38[0.15 - 0.98]）和苔藓化（0.47[0.22 - 0.98]）的AD发生率较高。确定了AD分布及相关体征的四个类别。
AD存在按年龄划分的不同表型，年轻患者出现更多的AD体征和症状。临床医生在管理AD时应予以考虑。
