Care Urged for Adult-Onset AD Diagnoses
As revolutionary as the latest approved therapeutics for atopic dermatitis have been, Daniela Kroshinsky, MD, MPH, cautioned that dermatologists must be vigilant and consider biopsies for atypical or nonresponsive cases before starting dupilumab or a JAK inhibitor.
Speaking at the Winter Clinical Hawaii 2025 meeting in Waikoloa Village, Hawaii, Dr. Kroshinsky emphasized the risk of undiagnosed atypical lymphocytic infiltrate or eczematous phase of bullous pemphigoid.
“We want to remember that the majority of eczema in adults is chronic or relapsing atopic dermatitis,” Dr. Kroshinsky said. “You will get that history of onset in childhood. Very often, when adults present outside of this history, it is something that, on biopsy, will carry a diagnosis change—or after patch testing.”
Of course, adult-onset atopic dermatitis, also known as idiopathic chronic eczematous eruption of aging, is a possibility. Dr. Kroshinsky cited a paper by Jonathan I. Silverberg, MD, PhD, MPH, that provides extensive detail on this condition.1
Still, Dr. Kroshinsky said adult-onset atopic dermatitis “should really be considered a diagnosis of exclusion after you have ruled out things like undiagnosed atypical lymphocytic infiltrate, eczematous based bullous pemphigoid, atypical late-onset drug reaction.”
“This is particularly important as we are seeing more and more adults with these misdiagnoses and putting them on a variety of other systemic agents,” she said.
- Silverberg JI. Adult-Onset Atopic Dermatitis. J Allergy Clin Immunol Pract. 2019;7(1):28-33.