Atopic dermatitis in older adults: A viewpoint from geriatric dermatology

Atopic dermatitis (AD) in older adults represents a newly defined subgroup of AD. The prevalence of elderly AD is approximately 1-3% among elderly populations in industrialized countries. Elderly patients with AD show some common clinical characteristics, such as a male predominance, a lower incidence of lichenified eczema at the elbow and knee folds, and particular patterns of onset and clinical course. Both immunoglobulin (Ig)E-allergic and non-IgE-allergic types are observed in elderly AD. Elderly patients with IgE-allergic AD show high rates of positivity for specific IgE antibodies against house dust mites, associations with IgE allergic and asthmatic complications, histopathological features with a predominance of IgE-mediated allergic inflammation in the lesional skin, and a significantly lower incidence of malignancy as compared with control subjects. The etiology of elderly AD might be associated with immunosenescence, age-related changes to the sex hormone milieu, age-related barrier dysfunctions in the skin and gut, functional disturbance of sweat production, and environmental stimuli in the lifestyle of elderly individuals. Powerful anti-inflammatory treatments, such as oral corticosteroids, might be required together with standard treatments to manage moderate to severe cases of elderly AD. Finally, most elderly patients with AD reach the end of life with this disease, which should now be considered a lifelong allergic disease.