How does atopic dermatitis present at different ages?
| | Fig. 8.1 Phases of atopic dermatitis. A, Infantile phase. Typical erythematous, oozing, and crusted plaques seen on the cheek of an infant with atopic dermatitis. B, Childhood phase. A 5-year-old child with oozing, crusted lesions with secondary excoriations on the thigh and calf. C, Adolescent/young adult phase. Characteristic chronic flexural dermatitis in an adolescent. (Panel A courtesy of the William L. Weston, M.D. collection; panel C courtesy of James E. Fitzpatrick, MD.) | Atopic dermatitis may present at any age, but 60% of patients experience their first outbreak by their first birthday, and 90% by their fifth. Four clinical phases are recognized: - Infantile (2 months to 2 years)
- Distribution: Cheeks (Fig. 8-1A), face and scalp, extensor surfaces of extremities and trunk (due to friction from crawling)
- Morphology: Erythema, papules, vesicles, oozing, and crusting
- Clearing: Dermatitis clears in half of the patients by 3 years of age
- Childhood (3 to 11 years)
- Distribution: Wrists, ankles, backs of the thighs, buttocks, and antecubital and popliteal fossae (Fig. 8-1B)
- Morphology: Chronic, lichenified scaly patches and plaques that may have crusting and oozing (see Fig. 8-1B)
- Clearing: Two thirds of patients clear by age 6
- Adolescent/young adult (12 to 20 years)
- Distribution: Face, neck, arms, back, and flexures (Fig. 8-1C)
- Morphology: Thick, dry, lichenified plaques without weeping, crusting, or oozing
- Clearing: 90% or patients clear by age 18
- Adult (.20 years)—50% of all patients will have recurrences as adults
- Distribution: Most commonly involves the hands, sometimes the face and neck, and rarely diffuse areas
- Morphology: Lichenified plaques, fissures on the hands, occasional vesicular outbreaks, one subset of “sensitive skin” patients.
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