DIAGNOSTIC CRITERIA AND CLINICAL COURSE OF ATOPIC DERMATITIS IN ADULTS
Objective: to analyze Atopic dermatitis (AD) diagnostics criteria routinely used for diagnosis as well as common findings and history in adult patients with different age of onset of the disease.
Materials and methods. 123 adult patients aged between 18 and 58 years with AD relapse were examined. The diagnosis was confirmed according to Ukrainian guidelines on AD. The patients were randomized in 2 groups depending on AD age of onset: 67 patients had AD start in early childhood and puberty, 56 patients – in adulthood. Precise medical history of the patients, clinical symptoms were collected. The disease severity was evaluated with SCORAD index and itch severity scale. Results were analyzed using parametric and nonparametric statistical tools.
Results. Depending on age of AD onset patients demonstrated some differences in diagnostic criteria positivity, past and actual clinical features of the disease, cooperation with health system specialists. Among major AD diagnostic criteria personal or family history of atopy and flexural lichenification in adults were detected as variable signs of the disease depending on age of onset. Family history of atopy stayed hidden information for part of the patients and could not be verified. The most often minor criteria detected positive and used for AD diagnosis in adults were xerosis, itching when sweating, facial pallor or erythema and white dermographism, with their different frequency among groups. 17,9% of cases in childhood and 25% of cases in adults were not initially recognized as AD and managed as another skin disease for months or years. Skin itch as constant sign of AD is provoked by different triggered with high prevalence of emotional stress in adult-onset AD and different frequency of contact triggers among groups. Emotional trauma was considered by the patients as a major trigger of mild relapses in adult-age AD and moderate relapses in early-age AD. Constant and severe xerosis was more common for patients with AD onset in childhood and was mostly not a significant impacting issue for adult-aged AD. Secondary pyoderma accompanies AD relapses of both groups. 100% of examined patients had experience of self-treatment with topical and systemic medications. Physical modalities of treatment (sunbathing, change of climate etc.) are less often of adult-age AD patients’ choice and provide good results more for early onset AD patients. Steroid-phobia was observed in patients with early disease onset only and is not an issue for adult-age AD patients.
Conclusions. Diagnostic criteria stay an important tool for diagnosing AD. Adult patients may demonstrate different set of positive major and minor criteria depending on time of the disease onset. Established diagnosis of AD may not correspond to first manifestation of the disease that is possible both in childhood and adult patients.
Prognosing of AD course in adults may depend on general duration of the disease: starting in childhood AD more often has seasonal relation, constant xerosis, irritation by sweeting; patients have long experience of moisturizers and physical treatments use. If started in adulty AD more often aggravates due to emotional and occupational triggers, then others; long-term use of moisturizers more probably would be neglected by the patient.
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