Differences in clinical phenotype between childhood-onset and adult-onset atopic dermatitis: a cross-sectional study

Introduction: Atopic dermatitis (AD) is the most common and burdensome inflammatory skin disease worldwide1. AD is heterogeneous both in its clinical presentation and response to treatment, and it is important to understand how adult-onset AD differs from childhood-onset and whether prevention and treatment strategies should differ. Methods: We performed a cross-sectional study of 18 participants ages 18+ from UCSF dermatology clinics in which we performed clinical assessments and collected patient-reported outcome data using validated surveys. We measured skin barrier function using transepidermal water loss (TEWL) and stratum corneum hydration (SCH) and calculated a frailty score. Results: Adult-onset patients had greater AD severity, worse experience with AD, poorer quality of life, and greater pruritis. In contrast, investigators’ global assessment of AD severity was the same among both groups. Regarding barrier function, TEWL was comparable between both groups, and SCH was higher in childhood-onset AD. We observed several differences in clinical presentation between childhood-onset and adult-onset AD. Adult-onset patients had more severe AD in the trunk and lower extremities, had a higher tendency toward cutaneous infections, were more pruritic, had less facial pallor or erythema, less pityriasis alba, and less Dennie-Morgan infraorbital folds. Discussion: Patient-reported outcomes, including the NRS or more detailed clinical severity scores like EASI and SCORAD, may be more likely to identify differences in severity among adults with AD than a global assessment score. We encourage the use of scales like the NRS and DLQI among the adult AD population, as pruritus and mental health comorbidities are especially common in this population. We recommend the use of frailty scores, especially for older adults, as they can help providers understand the full burden of disease.