Late onset atopic dermatitis and vitiligo: A case report

Year 2017, Volume: 39 Issue: 2, 507 - 508, 16.05.2017

Sibel Berksoy Hayta Rukiye Güner Melih Akyol

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 pattern².
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. AD 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.

Keywords

Letter

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.