Clinical Manifestation: Adult-Type Atopic Dermatitis

Fig. 17.1

Intractable erythema of the face: erythema of the face is a common manifestation in adult (adolescence/adulthood) phase. It is characterized by edematous erythema and many papules and is incurable

Fig. 17.2

Serous or crusted papules and erosions of forearm after scratching with intensity

Fig. 17.3

Prurigo

Fig. 17.4

Lichenification

Fig. 17.5

Dry skin

Fig. 17.6

Scratch marks with white dermography

Fig. 17.7

Dirty neck

There are many causes of symptoms of adult AD patients which are side effect of long-term use of topical corticosteroids [7], psychological stress [8], or some occupational environments including working at a restaurant, hair salon, hospital, etc. [9]. Hand eczema (Fig. 8) is also a common symptom for them, and it is intractable. It is caused by constantly exposing to various antigens and washing hands many times.

Fig. 17.8

Hand eczema

Furthermore, long-term inappropriate treatment without identifying and eliminating the individual risk factor like various antigens for AD patients frequently leads to the severe condition like erythroderma (Fig. 9).

Fig. 17.9

Erythroderma

17.3 Manifestations Characteristic of AD

17.3.1 Prurigo (Fig. 3)

Prurigo is an intractable condition of unknown etiology in which there are independent itchy papules or solid nodular eruptions. It is induced by diabetes mellitus, chronic renal failure, internal malignancies, or atopic condition and is aggravated by repeated itching and scratching. There are various studies about its etiology. Hashimoto et al. established prurigo model mouse, and they present that the condition is a basophil-dependent allergic inflammation [11].

17.3.2 Lichenification (Fig. 4)

Lichenification is a chronic skin disorder which is a thickened skin condition with accentuated skin markings like an elephant, usually the result of constant scratching and rubbing. It presents elevated sulcus cutis, clear crista cutis, and dryness of area cutanea.

17.3.3 Dry Skin (Fig. 5)

This is the common feature of atopic dermatitis among all ages. Increase of transepidermal water loss (TEWL) and decrease of water holding capacity (WHC) cause skin dryness in AD [5]. Sweating is thought to be a major source of water in the stratum corneum. And the functional abnormality of the stratum corneum in AD patients might impair the evaluation of WHC, even in cases of sufficient sweat volume [6].

17.3.4 Scratch Marks with White Dermographism (Fig. 6)

In adult (adolescence/adulthood) phase, atopic eczema is found commonly in the upper chest. This is the photograph of “white dermography” on the upper chest region. Patients of AD often develop the symptom when they scratch their skin lightly. It is characterized by blood vessel constriction, and the white scratch mark appears for over an hour.

17.3.5 Dirty Neck (Fig. 7)

Dirty neck is a protracted condition with various manifestations such as reticulate pigmentation, erythema, papules, and scratch marks. The main manifestation is reticulate pigmentation; skin atrophy, depigmentation, and telangiectasia appear in its development to a completely poikiloderma-like lesion. It is also called ripple pigmentation of the neck or poikiloderma-like skin changes and is attributable to chronic inflammation and prolonged using topical corticosteroid for treatment [12].

17.3.6 Hand Eczema (Fig. 8)

Hand eczema is characterized by xerosis, fissures, lichenification, etc. The nails are often coarse pitting and ridging.

It is an intractable and common symptom for AD patients whose skin barrier function is impaired. We constantly touch various antigens or irritants such as foods, pet animals, and chemical cleanser etc. And the people who work at a restaurant, hospital, or hair salon wash their hands many times. For AD patients whose skin barrier function is impaired, hand eczema is common and intractable. In addition, AD patients who work with papers and metals and take care of their baby or child often show severe hand eczema [10].

17.3.7 Erythroderma (Fig. 9)

Erythroderma is an inflammatory skin condition in which erythema and scaling affect nearly the entire body surface. It is induced by prolonged inappropriate or no treatment and is sometimes triggered by infection.