[Senile atopic dermatitis - current vision and unresolved issues.]

Atopic dermatitis (AD) is one of the most common dermatoses with a complex multifactorial pathogenesis including genetic predisposition, epidermal dysfunction, immune dysregulation, and disruption of the skin microbial landscape. The clinical picture of AD is characterized by age-related dynamics with changes in the morphology and localization of the skin rash; there are infantile, childhood, and adult stages of dermatosis. In recent years, the term «senile AD» has also been discussed for patients aged 60 and older. This form of the disease is supposed to have a number of features of pathogenesis and clinical manifestations due to age-related skin involution and aging of the body as a whole, which requires correction of traditional approaches to diagnosis and therapy of the disease. The presented review systematizes the data on epidemiology, pathogenesis, clinical manifestations and treatment of AD in elderly and senile patients. The analysis of the literature revealed that the epidemiological data on the incidence of AD in elderly and senile patients are solitary and contradictory. The peculiarities of the pathogenesis of this form of dermatosis are synergistic changes in the skin barrier and immune function, which leads to a more severe course of dermatosis. The contribution to the pathogenesis and character of the course of AD of somatic diseases characteristic of the aged over 60 and the therapy patients receive for these comorbidities, as well as the peculiarities of the lifestyle of the elderly and irrational skin care are discussed. There are few data on the specifics of treatment of elderly and senile patients with AD; in severe forms of dermatosis, low-dose dupilumab and methotrexate are suggested as the systemic therapy of choice.