Infants and children are most often affected, with 85% of cases appearing in the first year of life and 95% of cases appearing by 5 years. Uncommonly, the condition may persist into, or even arise in, adulthood. Less than 1% of adults are affected by atopic dermatitis.
In infants, the disease involves primarily the face, scalp, and torso. In children and adults, the disease usually involves chiefly the flexural aspects of extremities, but it may be more generalized. Children of African descent may present with an infantile distribution of lesions even later in childhood. Follicular patterns (ie, follicular eczema) are more common in darker skin phototypes. A lichen planus-like appearance has also been reported in persons with darker skin phototypes, due to lichenification and the difficulties in perceiving erythema in darker skin.
Atopic dermatitis may be categorized as follows:
- Acute – erythema, vesicles, bullae, weeping, crusting
- Subacute – scaly plaques, papules, round erosions, crusts
- Chronic eczema – lichenification, scaling, hyper- and hypopigmentation
Intense pruritus is a hallmark of atopic dermatitis. Scratching leads to lichenification (skin thickening). Impaired barrier function increases transepidermal water loss and the risk of bacterial and viral cutaneous infections. Patients with atopic dermatitis are prone to impetiginization with Staphylococcus aureus. Secondary infections with herpes simplex virus (eczema herpeticum), molluscum contagiosum, Coxsackie virus, or vaccinia virus (eczema vaccinatum) can occur.
Patients with atopic dermatitis have difficulties in retaining skin moisture and suffer from xerosis (dry skin). Environmental triggers, such as heat, humidity, detergents / soaps, abrasive clothing, chemicals, smoke, and even stress, tend to aggravate the condition. Latex allergy and nickel allergy occur more often in persons with atopic dermatitis. Additionally, patients with atopic dermatitis have been found to be more likely to have positive patch test results to products commonly found in topical treatments, including cocamidopropyl betaine, wool alcohol / lanolin, and tixocortol pivalate. Allergy to eggs, cow's milk, or peanuts is common. There may be a relationship between atopic dermatitis and the development of aspirin-related respiratory disease.
Atopic dermatitis is increasing in the developed world. In the United States, about 10% of children may be affected by atopic dermatitis, but the majority of these cases are mild. Mild cases may improve in adulthood, although some may retain stigmata of dry or sensitive skin.
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