Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly

Abstract

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features.

Keywords: atopic eczema; clinical characteristics; complications; elderly; immunoglobulin E; onset; outcomes; prognosis; skin manifestations; treatment.

Figure 1

Age at onset of atopic eczema in elderly patients.

Figure 2

Age at bronchial asthma (BA) onset in elderly patients with atopic eczema. Abbreviations: AE, atopic eczema; BA, bronchial asthma; ① childhood-onset AE, outgrow-recurrence type; ② childhood-onset AE, continuous type; ③ adolescent and young adult-onset AE, outgrow-recurrence type; ④ adolescent and young adult-onset AE, continuous type; ⑤ late adult-onset AE; ⑥ senile-onset AE; ⑦ senile-onset AE.

Figure 3

Positive rate (top) and average of positive scores (bottom) of specific IgEs in elderly patients with atopic eczema. Abbreviations: AE, atopic eczema; Der f, Dermatophagoides farinae; JC, Japanese cedar; SVG, sweet vernal grass. # Average of class intensity (score) of the positive allergens for multiple antigen simulations test (MAST)-26 or MAST-33; the adjust class intensity for the common 26 allergens are decided as follows: score 1 (mild) = class 1 for MAST26 or class 2 for MAST33; score 2 (moderate) = class 2 for MAST26 or class3 for MAST33; score 3 (strong) = class 3 for MAST26 or class 4, 5 and 6 for MAST33; score 4 (very strong) = over class 3 for MAST26 or over class 6 for MAST33.

Figure 4

Skin manifestations of elderly patients with atopic eczema (AE). (a) Facial eczematous erythema (atopic red face) with Hertoghe’s sign (loss of lateral eyebrows); (b) Diffuse eczematous erythema and papules on the neck and upper back; (c) Lichenified eczema of erythroderma on the trunk; (d) Nummular-form eczema with acute inflammation on the back; (e) Nummular-form eczema changed to exudative inflammatory erythema after 1 week; (f) Prurigo-forming papules and nodules on the upper extremities and trunk.

Figure 5

Lichenification (lichenified eczema) in the antecubital areas of elderly patients with atopic eczema (AE). (a) Localized lichenified eczema in the elbow fold; (b) Diffuse lichenified eczema in the elbow fold and flexure site of the arm; (c) Lichenified eczema around the scarcely involved elbow fold (reverse sign).

Figure 6

Treatment progress of elderly patients with atopic eczema. * IgE-allergic: n = 34, OSCORAD = 38.5 ± 17.6; Indeterminate-allergic: n = 8, OSCORAD = 24.1 ± 7.8; Non-IgE-allergic: n = 10, OSCORAD = 28.5 ± 18.2. ** IgE-allergic standard: n = 18, OSCORAD = 35.7 ± 16.3; IgE-allergic OCS: n = 16, OSCORAD = 41.6 ± 19.1; Indeterminate-allergic standard: n = 2, OSCORAD = 28.7 ± 6.4; Indeterminate-allergic OCS: n = 6, OSCORAD = 22.5 ± 8.0; Non-IgE-allergic standard: n = 5, OSCORAD = 19.3 ± 7.9; Non-IgE-allergic OCS: n = 5, OSCORAD = 37.7 ± 21.7; Total standard: n = 25, OSCORAD= 31.8 ± 15.6; Total OCS: n = 27, OSCORAD = 36. 7± 18.9. Abbreviations: AE, atopic eczema; standard, standard treatments (including topical corticosteroids and moisturizer, oral antihistamines, oral anti-allergic drugs, and topical tacrolimus); OCS, standard treatment with oral corticosteroids; OSCORAD, Objective Severity Scoring of Atopic Dermatitis (mean ± SD).

Figure 6

Treatment progress of elderly patients with atopic eczema. * IgE-allergic: n = 34, OSCORAD = 38.5 ± 17.6; Indeterminate-allergic: n = 8, OSCORAD = 24.1 ± 7.8; Non-IgE-allergic: n = 10, OSCORAD = 28.5 ± 18.2. ** IgE-allergic standard: n = 18, OSCORAD = 35.7 ± 16.3; IgE-allergic OCS: n = 16, OSCORAD = 41.6 ± 19.1; Indeterminate-allergic standard: n = 2, OSCORAD = 28.7 ± 6.4; Indeterminate-allergic OCS: n = 6, OSCORAD = 22.5 ± 8.0; Non-IgE-allergic standard: n = 5, OSCORAD = 19.3 ± 7.9; Non-IgE-allergic OCS: n = 5, OSCORAD = 37.7 ± 21.7; Total standard: n = 25, OSCORAD= 31.8 ± 15.6; Total OCS: n = 27, OSCORAD = 36. 7± 18.9. Abbreviations: AE, atopic eczema; standard, standard treatments (including topical corticosteroids and moisturizer, oral antihistamines, oral anti-allergic drugs, and topical tacrolimus); OCS, standard treatment with oral corticosteroids; OSCORAD, Objective Severity Scoring of Atopic Dermatitis (mean ± SD).

Figure 7

Complication of malignancy in elderly patients with atopic eczema and controls.