Approximately 1 in 4 adults report the onset of adult eczema and the rest its onset is from childhood. Eczema is an ill-defined skin lesions and it includes patches, papules, and plaques with different degrees of redness and swelling. It can affect any skin site but they most classically affect the creases of the elbows and knees. Other commonly reported areas are the head, neck, hands or feet.
Adult eczema can present differently from childhood eczema. Adult was found to present with different lesions with a greater predilection for the head/neck and/or hands and feet. Also other diseases need to be considered including mycosis fungoides/cutaneous T-cell lymphoma (CTCL) and psoriasis.
Previous studies have shown that a substantial proportion of patients were reported to have adult eczema after 50 years of age. Another study showed that foreign-born patients were more likely to have adult eczema compared to those born in the U.S. This may be related to different climate or other environmental factors.
Similar to child onset eczema, adult eczema presents with a chronic, relapsing or persistent itchy red rash.
Other etiologies of a new onset rash in adults are broad, here are some other causes that need to be considered:
Allergic contact dermatitis, mycosis fungoide/CTCL, psoriasis, scabies, eczematous drug eruption, dermatophyte infection, autoimmune blistering disease (dermatitis herpetiformis, bullous pemphgoid, and pemphigus vulgaris), Autoimmune connective tissue disease, Churg-Strauss Syndrome, Paraneoplastic dermatitis, Wiskott Aldrich Syndrome and other immunodeficiency syndromes.
Testing for adult onset eczema can include:
- Skin biopsy-although it is not required. A punch biopsy with standard staining can be helpful.
- Skin scraping to help exclude scabies or fungal infections
- Patch testing to rule out allergic contact dermatitis
- Skin prick, IgE and eosinophil testing. It is not required as adults as adult eczema has a lower rate of allergy disease compared to children.
- Additional lab testing can include a CBC, ANCA, ANA, complement levels, ESR, HIV testing.
Management is similar to childhood onset atopic dermatitis, including basic skin care and trigger avoidance. If patients fail different topical treatments, phototherapy, Dupixent and/or immunosuppressants should be added.
Little is known about the duration and course of adult eczema. Adult eczema can be very burdensome with major quality of life impacts and associated with numerous medical and mental health comorbidities. Some include, anxiety, depression and skin infections.