Atopic Dermatitis in the Elderly Population
DOI:
https://doi.org/10.2340/actadv.v103.13363Keywords:
atopic dermatitis in elderly, atopic dermatitis, elderly, older patients, treatmentAbstract
Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile.
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References
Chiricozzi A, Maurelli M, Calabrese L, Peris K, Girolomoni G. Overview of atopic dermatitis in different ethnic groups. J Clin Med 2023; 12: 2701.
https://doi.org/10.3390/jcm12072701 DOI: https://doi.org/10.3390/jcm12072701
Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema - part I: systemic therapy. J Eur Acad Dermatol Venereol 2022; 36: 1409-1431.
https://doi.org/10.1111/jdv.18345 DOI: https://doi.org/10.1111/jdv.18345
Katsarou A, Armenaka M. Atopic dermatitis in older patients: particular points. J Eur Acad Dermatol Venereol 2011; 25: 12-18.
https://doi.org/10.1111/j.1468-3083.2010.03737.x DOI: https://doi.org/10.1111/j.1468-3083.2010.03737.x
Tanei R, Hasegawa Y. Atopic dermatitis in older adults: a viewpoint from geriatric dermatology. Geriatr Gerontol Int 2016; 16: 75-86.
https://doi.org/10.1111/ggi.12771 DOI: https://doi.org/10.1111/ggi.12771
Girolomoni G, de Bruin-Weller M, Aoki V, Kabashima K, Deleuran M, Puig L, et al. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis 2021; 12: 20406223211002979.
https://doi.org/10.1177/20406223211002979 DOI: https://doi.org/10.1177/20406223211002979
Chan LN, Magyari A, Ye M, Al-Alusi NA, Langan SM, Margolis D, et al. The epidemiology of atopic dermatitis in older adults: a population-based study in the United Kingdom. PLoS One 2021; 16: e0258219.
https://doi.org/10.1371/journal.pone.0258219 DOI: https://doi.org/10.1371/journal.pone.0258219
Lusignan de S, Alexander H, Broderick C, Dennis J, McGovern A, Feeney C, et al. The epidemiology of eczema in children and adults in England: a population-based study using primary care data. Clin Exp Allergy 2021; 51: 471-482.
https://doi.org/10.1111/cea.13784 DOI: https://doi.org/10.1111/cea.13784
Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol 2013; 132: 1132-1138.
https://doi.org/10.1016/j.jaci.2013.08.031 DOI: https://doi.org/10.1016/j.jaci.2013.08.031
Silverberg JI, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, et al. Distribution of atopic dermatitis lesions in United States adults. J Eur Acad Dermatol Venereol 2019; 33: 1341-1348.
https://doi.org/10.1111/jdv.15574 DOI: https://doi.org/10.1111/jdv.15574
Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol 2020; 182: 47-54. DOI: https://doi.org/10.1111/bjd.17896
https://doi.org/10.1111/bjd.18652 DOI: https://doi.org/10.1111/bjd.18652
Bozek A, Fisher A, Filipowska B, Mazur B, Jarzab J. Clinical features and immunological markers of atopic dermatitis in elderly patients. Int Arch Allergy Immunol 2012; 157: 372-378.
https://doi.org/10.1159/000329150 DOI: https://doi.org/10.1159/000329150
Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, Chu AWL, Ceccaci R, et al. Allergen immunotherapy for atopic dermatitis: systematic review and meta-analysis of benefits and harms. J Allergy Clin Immunol 2023; 151: 147-158.
https://doi.org/10.1016/j.jaci.2022.09.020 DOI: https://doi.org/10.1016/j.jaci.2022.09.020
Hui-Beckman JW, Goleva E, Berdyshev E, Leung DYM. Endotypes of atopic dermatitis and food allergy. J Allergy Clin Immunol 2023; 151: 26-28.
https://doi.org/10.1016/j.jaci.2022.07.021 DOI: https://doi.org/10.1016/j.jaci.2022.07.021
Garcovich S, Maurelli M, Gisondi P, Peris K, Yosipovitch G, Girolomoni G. Pruritus as a distinctive feature of type 2 inflammation. Vaccines (Basel) 2021; 9: 303.
https://doi.org/10.3390/vaccines9030303 DOI: https://doi.org/10.3390/vaccines9030303
Yosipovitch G, Gooderham MJ, Ständer S, Fonacier L, Szepietowski JC, Deleuran M, et al. Interpreting the relationship among itch, sleep, and work productivity in patients with moderate-to-severe atopic dermatitis: a post hoc analysis of JADE MONO-2. Am J Clin Dermatol 2023 Aug 25. [Epub ahead of print].
https://doi.org/10.1007/s40257-023-00810-7 DOI: https://doi.org/10.1007/s40257-023-00810-7
Bruin-Weller de M, Gadkari A, Auziere S, Simpson EL, Puig L, Barbarot S, et al. The patient-reported disease burden in adults with atopic dermatitis: a cross-sectional study in Europe and Canada. J Eur Acad Dermatol Venereol 2020; 34: 1026-1036.
https://doi.org/10.1111/jdv.16003 DOI: https://doi.org/10.1111/jdv.16003
Beck LA, Cork MJ, Amagai M, De Benedetto A, Kabashima K, Hamilton JD, et al. Type 2 inflammation contributes to skin barrier dysfunction in atopic dermatitis. JID Innov 2022; 2:100131.
https://doi.org/10.1016/j.xjidi.2022.100131 DOI: https://doi.org/10.1016/j.xjidi.2022.100131
Renert-Yuval Y, Del Duca E, Pavel AB, Fang M, Lefferdink R, Wu J, et al. The molecular features of normal and atopic dermatitis skin in infants, children, adolescents, and adults. J Allergy Clin Immunol 2021; 148: 148-163.
https://doi.org/10.1016/j.jaci.2021.01.001 DOI: https://doi.org/10.1016/j.jaci.2021.01.001
Del Duca E, Renert-Yuval Y, Pavel AB, Mikhaylov D, Wu J, Lefferdink R, et al. Proteomic characterization of atopic dermatitis blood from infancy to adulthood. J Am Acad Dermatol 2023; 88: 1083-1093.
https://doi.org/10.1016/j.jaad.2022.12.050 DOI: https://doi.org/10.1016/j.jaad.2022.12.050
Zhou L, Leonard A, Pavel AB, Malik K, Raja A, Glickman J, et al. Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol 2019; 144: 144-156.
https://doi.org/10.1016/j.jaci.2019.01.015 DOI: https://doi.org/10.1016/j.jaci.2019.01.015
Wang S, Zhu R, Gu C, Zou Y, Yin H, Xu J, et al. Distinct clinical features and serum cytokine pattern of elderly atopic dermatitis in China. J Eur Acad Dermatol Venereol 2020; 34: 2346-2352.
https://doi.org/10.1111/jdv.16346 DOI: https://doi.org/10.1111/jdv.16346
Facheris P, Da Rosa JC, Pagan AD, Angelov M, Del Duca E, Rabinowitz G, et al. Age of onset defines two distinct profiles of atopic dermatitis in adults. Allergy 2023; 78: 2202-2214.
https://doi.org/10.1111/all.15741 DOI: https://doi.org/10.1111/all.15741
Liu P, Zhao Y, Mu ZL, Lu QJ, Zhang L, Yao X, et al. Clinical features of adult/adolescent atopic dermatitis and Chinese criteria for atopic dermatitis. Chin Med J (Engl) 2016; 129: 757-762.
https://doi.org/10.4103/0366-6999.178960 DOI: https://doi.org/10.4103/0366-6999.178960
Yue W, Cheng D, Sun Z, Shen Y, Wang S, Liu X, et al. Validation of diagnostic criteria for atopic dermatitis and proposal of novel diagnostic criteria for adult and elderly Chinese populations: a multicentre, prospective, clinical setting-based study. Br J Dermatol 2023; 188: 420-426.
https://doi.org/10.1093/bjd/ljac097 DOI: https://doi.org/10.1093/bjd/ljac097
Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, et al. Committee for clinical practice guidelines for the management of atopic dermatitis 2021, the Japanese society of allergology, The Japanese Dermatology Association. Executive summary: Japanese guidelines for atopic dermatitis (ADGL) 2021. Allergol Int 2022; 71: 448-458.
https://doi.org/10.1016/j.alit.2022.06.009 DOI: https://doi.org/10.1016/j.alit.2022.06.009
Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special patient populations. J Eur Acad Dermatol Venereol 2022; 36: 1904-1926.
https://doi.org/10.1111/jdv.18429 DOI: https://doi.org/10.1111/jdv.18429
Kolkhir P, Akdis CA, Akdis M, Bachert C, Bieber T, Canonica GW, et al. Type 2 chronic inflammatory diseases: targets, therapies and unmet needs. Nat Rev Drug Discov 2023; 22: 743-767.
https://doi.org/10.1038/s41573-023-00750-1 DOI: https://doi.org/10.1038/s41573-023-00750-1
Dhadwal G, Albrecht L, Gniadecki R, Poulin Y, Yeung J, Hong CH, et al. Approach to the assessment and management of adult patients with atopic dermatitis: a consensus document. Section IV: treatment options for the management of atopic dermatitis. J Cutan Med Surg 2018; 22: 21S-29S.
https://doi.org/10.1177/1203475418805721 DOI: https://doi.org/10.1177/1203475418805721
Adam DN, Gooderham MJ, Beecker JR, Hong CH, Jack CS, Jain V, et al. Expert consensus on the systemic treatment of atopic dermatitis in special populations. J Eur Acad Dermatol Venereol Venereol 2023; 37: 1135-1148.
https://doi.org/10.1111/jdv.18922 DOI: https://doi.org/10.1111/jdv.18922
Patruno C, Napolitano M, Argenziano G, Peris K, Ortoncelli M, Girolomoni G, et al. Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study. J Eur Acad Dermatol Venereol 2021; 35: 958-964.
https://doi.org/10.1111/jdv.17094 DOI: https://doi.org/10.1111/jdv.17094
Russo F, Milanesi N, Cartocci A, Bruzziches F, Tronconi G, Lazzeri L, et al. Dupilumab in elderly patients with severe atopic dermatitis. Dermatitis 2021; 32: S24-S27.
https://doi.org/10.1097/DER.0000000000000686 DOI: https://doi.org/10.1097/DER.0000000000000686
Silverberg JI, Lynde CW, Abuabara K, Patruno C, de Benedetto A, Zhang H, et al. Efficacy and safety of dupilumab maintained in adults ≥ 60 years of age with moderate-to-severe atopic dermatitis: analysis of pooled data from four randomized clinical trials. Am J Clin Dermatol 2023; 24: 469-483.
https://doi.org/10.1007/s40257-022-00754-4 DOI: https://doi.org/10.1007/s40257-022-00754-4
Merola JF, Butler DC, Mark T, Schneider S, Kim Y, Abuabara K. Safety and efficacy of tralokinumab in older adults with moderate-to-severe atopic dermatitis: a secondary analysis. JAMA Dermatol JAMA Dermatol 2023; 159: 1119-1123.
https://doi.org/10.1001/jamadermatol.2023.2626 DOI: https://doi.org/10.1001/jamadermatol.2023.2626
Pezzolo E, Schena D, Gambardella A, Rossi M, Barei F, Calzavara Pinton P, et al. Survival, efficacy and safety of tralokinumab after 32 and 52 weeks of treatment for moderate-to-severe atopic dermatitis in adults: a multicentre real-world study. J Eur Acad Dermatol Venereol 2023 Jul 22. [Epub ahead of print].
https://doi.org/10.1111/jdv.19382 DOI: https://doi.org/10.1111/jdv.19382
García Castro R, Heras Mendaza F, Santiago Sánchez-Mateos DI, Fariña Sabrís MC, Alcaraz León I. First short-term effectiveness and security data of tralokinumab in severe atopic dermatitis in real clinical practice. Dermatitis 2023 May 2. [Epub ahead of print].
https://doi.org/10.1089/derm.2023.0030 DOI: https://doi.org/10.1089/derm.2023.0030
Philippoteaux C, Deprez V, Nottez A, Cailliau E, Houvenagel E, Deprez X, et al. Characteristics of patients treated with JAK inhibitors in rheumatoid arthritis before versus after VTE risk warnings. J Clin Med 2022; 12: 207.
https://doi.org/10.3390/jcm12010207 DOI: https://doi.org/10.3390/jcm12010207
Winthrop KL, Cohen SB. Oral surveillance and JAK inhibitor safety: the theory of relativity. Nat Rev Rheumatol 2022; 18: 301-304.
https://doi.org/10.1038/s41584-022-00767-7 DOI: https://doi.org/10.1038/s41584-022-00767-7
https://www.ema.europa.eu/en/news/ema-recommends-measures-minimise-risk-serious-side-effects-janus-kinase-inhibitors-chronic. [accessed 5 May 2023]
Piscazzi F, Gargiulo L, Ibba L, Valenti M, Facheris P, Costanzo A, et al. Upadacitinib for the treatment of atopic dermatitis in the elderly: an Italian case series of seven patients. J Dermatolog Treat 2023; 34: 2245510.
https://doi.org/10.1080/09546634.2023.2245510 DOI: https://doi.org/10.1080/09546634.2023.2245510
Lam M, Zhu JW, Maqbool T, Adam G, Tadrous M, Rochon P, et al. Inclusion of older adults in randomized clinical trials for systemic medications for atopic dermatitis: a systematic review. JAMA Dermatol 2020; 156: 1240-1245.
https://doi.org/10.1001/jamadermatol.2020.2940 DOI: https://doi.org/10.1001/jamadermatol.2020.2940
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Copyright (c) 2023 Martina Maurelli, Andrea Chiricozzi, Ketty Peris, Paolo Gisondi, Giampiero Girolomoni
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