Atopic dermatitis in adults: prevalence, clinical pattern, and contact sensitization

Abstract

Aim: Few reports on atopic dermatitis (AD) in adults from Africa exist in the literature. AD in adults can occur as childhood-onset, in which AD begins in childhood and continues till adulthood, or adult-onset, in which AD develops in adulthood. Typical appearance of AD includes acute or chronic eczematous lesions recurring or chronic in nature that is symmetrically distributed on flexural body surfaces. Atypical clinical patterns and morphology are commonly described among the adult population. The purpose of this study is to describe the frequency, clinical pattern, and contact sensitization of adults with AD. Methods: A prospective study of patients seen at the dermatology clinic of a tertiary referral center in Abuja, Nigeria, between September 2020 and September 2022. Adult patients who fulfilled at least three major and three minor criteria of the Hanifin and Rajka guidelines were recruited. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index for black skin was used to determine AD severity. Contact sensitivity was assessed using a modified European baseline series and skin prick testing of common aeroallergens was also done. Results: Out of a total of 2,177 patients, only 38 adults were diagnosed with AD. Two-thirds of them had adult-onset AD. The majority (63.2%) had chronic eczema at presentation, 23.7% had perifollicular accentuations, and 13.2% had acute eczema. The mean SCORAD index was 20.5 (16.4 to 24.6). The mean eosinophil count was 5.9 ± 3.4 cells/dL. The skin prick test revealed sensitization to at least one allergen in 68.8% of the patients. Contact sensitivity to methyldibromoglutaronitrile, lanolin, and paraben was highly observed. Conclusions: Adult-onset AD is more common than childhood-onset AD in adults. The morphology and distribution of eczema did not differ from other studies. Adult AD individuals tend to develop contact sensitivity to preservatives.