Differences in Atopic Dermatitis Presentation Across Age Groups and Skin Types

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Demographic Data on Atopic Dermatitis

• Affects approximately 7% of adults, increasing 3% to 5% over last 5 years
• Slightly more common in women and people of multiple races
• Onset patterns: 58% of adults developed AD at age 18+, 25% at age 5 or younger, 24% at age 50+
• Age-specific distribution: 18-39 years (flexural surfaces, neck, elbows); 40+ years (neck, hands, face)
• Severity breakdown: 60% mild, 29% moderate, 11% severe

Distinguishing Features and Diagnosis

• Distribution patterns vary by age:
  • Infants: cheeks, scalp, extensor surfaces
  • Children: antecubital fossa, popliteal fossa, neck, wrists
  • Adults: flexural surfaces, neck, hands, eyelids
• Diagnostic aids: IgE blood work (elevated in 50%-60% of AD patients), elevated eosinophil count
• Clinical importance of the “atopic march”: progression from eczema to asthma, allergic rhinitis, and allergic conjunctivitis
• Early intervention may reduce development of atopic march by preventing skin barrier compromise

Clinical Presentation Variations

• Skin type impacts presentation: darker skin may show papular/follicular presentation with less visible erythema
• May appear violaceous rather than erythematous in darker skin types
• Chronicity factors: long-standing untreated eczema may develop into:
  • Lichen simplex chronicus (thickened plaques from scratch-itch cycle)
  • Prurigo nodularis (“picker’s nodules”)
• Common thread across variations: persistent, intense itching