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Late onset atopic dermatitis and vitiligo: A case report

Year 2017, Volume: 39 Issue: 2, 507 - 508, 16.05.2017
https://doi.org/10.7197/223.v39i29491.316373

Abstract



Dear Editor,



Adult-onset atopic
dermatitis (AOAD) (onset >18 years) is a subgroup of atopic dermatitis (AD).
This subgroup has been mentioned by Bannister and Freeman from Australia1.
It may have different morphologic variants.
Apart
from the
most
typical flexural localization and eczematous
pattern
in adults, patients may also have
a nonflexural distribution and other morphologic variants
such as nummular or prurigo-like pattern
2.
The Hannifin and Rajka criteria can be used to diagnose AOAD3. AD is
occasionally associated with vitiligo, and patients with vitiligo, especially
early onset may appear to have increased risk of AD4.



We present a rare
case with late onset atopic dermatitis and vitiligo. A 16 year old boy
suffering from itchy lesions and dryness on his whole body, especially on
flexural distributions for 6 months admitted to our out-patient policlinic. He
also complained depigmented lesions. No personal history of atopy. His mother
has an allergic rhinitis for many years.



Dermatologic
examination of the patient revealed pruritic dry skin, pilar keratosis, and
symmetric lichenified flexural eczema. He has a facial erythema, orbital
darkness and Dennie-Morgan folds (Figure 1).



Potassium hydroxide
preperations were negative. Histopathologic examination of the lesions showed
the findings of chronic dermatitis. The diagnosis of atopic dermatitis was made
based on Hanifin-Rajka criteria.

He has also
symmetric depigmented lesions on the popliteal skin area. Wood lamp examination
of these lesions revealed blue-white light areas with sharp margins.

Haematologic and
urine analysis, including IgE, ANA and antithyroid antibodies were in normal range.

Atopic dermatitis is a chronic or chronic relapsing,
the classic morphology and location of which
differs
depending on age, and which is usually
  associated with severe
pruritus. A
D is
a
common
skin disease, both in childhood and adolescence and in adults5. The
term
AOAD
(onset >18 years) was introduced by Bannister and Freeman1. The
onset age

of the disease in our case was 16. Because of that,
our case is not an
AOAD. However,
his diagnosis may be accepted as a late-onset atopic dermatitis.

There is lack of diagnostic criteria useful in both
children and adults. Therefore understanding the
natural
history of
AD
is complicated. The UK working party criteria may not perform
well
among adults6. Ozkaya1 reported that there is no problem
in detecting early-onset AD

according to The UK working criteria, but
approximately one fourth of patients could not be given
the
diagnosis of
AOAD
according to this in its current form. The criteria of Hanifin and
Rajka
have been considered as a gold standard for AD diagnosis for the last 20 years,
and this
criteria
was used in the diagnosis of our case. A diagnostic difficulty may arise when
the onset

occurs after the adolescence or later, as in these
cases the clinical pattern may be atypical. However
it may
still present with flexural dermatitis3. Our case had a typical
typical flexural distribution and
lichenified eczematous pattern.

AD
may be associated with specific subsets of vitiligo, and may indicate poor
prognostic
value for vitiligo. The mechanisms of association between
AD and
vitiligo
are
yet unknown. Patients with vitiligo, especially early onset, appear to have
increased risk of
AD4.
The onset time was almost the same for both diseases in our case. However,
while
our case has a late onset time for
AD,
but early onset for vitiligo.













Further studies are needed to explain the association
between atopic dermatitis and vitiligo, and
common
disease mechanisms for both diseases.

References

  • 1- Bannister MJ, Freeman S. Adult-onset atopic dermatitis. Australas J Dermatol 2000; 41: 225-8.
  • 2- Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol 2005; 52: 579-82.
  • 3- Kanwar AJ, Narang T. Adult-onset atopic dermatitis: under-recoginized or under-reported? Indian Dermatology Online Journal 2013; 4 167-71.
  • 4- Mohan GC, Siverberg J. Association of vitiligo and alopecia areata with atopic dermatitis: A systematic review and meta-analysis. JAMA Dermatol 2015; 151: 522-8.
  • 5- Werfel T, Heratizadeh A, Aberer W, et al. S2k guideline on diagnosis and treatment of atopic dermatitis – short version. JDDG 2016; 14: 92-105.
  • 6- Lan CC, Lee CH, Lu YW, et al. Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: a pilot study on validation of diagnostic questionnaires. J Am Acad Dermatol 2009;61: 806-12.
Year 2017, Volume: 39 Issue: 2, 507 - 508, 16.05.2017
https://doi.org/10.7197/223.v39i29491.316373

Abstract

References

  • 1- Bannister MJ, Freeman S. Adult-onset atopic dermatitis. Australas J Dermatol 2000; 41: 225-8.
  • 2- Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol 2005; 52: 579-82.
  • 3- Kanwar AJ, Narang T. Adult-onset atopic dermatitis: under-recoginized or under-reported? Indian Dermatology Online Journal 2013; 4 167-71.
  • 4- Mohan GC, Siverberg J. Association of vitiligo and alopecia areata with atopic dermatitis: A systematic review and meta-analysis. JAMA Dermatol 2015; 151: 522-8.
  • 5- Werfel T, Heratizadeh A, Aberer W, et al. S2k guideline on diagnosis and treatment of atopic dermatitis – short version. JDDG 2016; 14: 92-105.
  • 6- Lan CC, Lee CH, Lu YW, et al. Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: a pilot study on validation of diagnostic questionnaires. J Am Acad Dermatol 2009;61: 806-12.
There are 6 citations in total.

Details

Subjects Health Care Administration
Journal Section Letters to the Editor
Authors

Sibel Berksoy Hayta

Rukiye Güner

Melih Akyol

Publication Date May 16, 2017
Acceptance Date November 18, 2016
Published in Issue Year 2017Volume: 39 Issue: 2

Cite

AMA Berksoy Hayta S, Güner R, Akyol M. Late onset atopic dermatitis and vitiligo: A case report. CMJ. May 2017;39(2):507-508. doi:10.7197/223.v39i29491.316373