Clinical Diversity of Atopic Dermatitis: A Review of 5,000 Patients at a Single Institute

Abstract

Purpose: Atopic dermatitis (AD) is a chronic eczematous dermatitis that has a high prevalence and diverse clinical features. Although several hypotheses about its multifactorial pathogenesis have been suggested, the cause is not yet fully understood. A better understanding of the clinical features may helpful inelucidating the pathogenesis of AD.

Methods: This retrospective study analyzed the questionnaires, medical charts, and laboratory examination results of 5,000 patients diagnosed with AD at a single tertiary hospital in Korea.

Results: The demographics, allergic comorbidities, family history, severity, and treatment experiences of the patients were analyzed. Most of the patients were adults, 76.3% of whom were classified as havingan extrinsic type of AD. The mean eczema area and severity index (EASI) score was found to be 13.68, and adult patients were found to have higher severity than the other age groups. The anatomical involvements were different among the age groups, with more involvements of the head and neck in adults. The patients reported seasonal changes and stress as the factors that aggravated their symptoms the most. Topical steroids and oral cyclosporine were the most used medications at our clinic, whereas 10.1% of the patients underwent allergen-specific immunotherapy.

Conclusions: This analysis of 5,000 patients would lead to a better understanding of various subtypes and diverse clinical features of AD in Koreans. Distinct characteristics were observed among different age groups; thus, treatment strategies may need to be differentiated accordingly.

Keywords: Atopic dermatitis; clinical diversity.

Fig. 1. The proportion of extrinsic and intrinsic types according to different age groups. The age groups were defined as follows: infancy ≤2 years old, childhood and adolescence >2 years old and ≤18 years old, and adulthood>18 years old. The intrinsic type was defined as a total IgE of <150 kU/L and with no sensitization to allergens, whereas the extrinsic type was defined as a total IgE of >150 kU/L or a positive sensitization in CAP immunoassay.

Fig. 2. Evaluation of sensitization to specific allergens in CAP immunoassay. D. pteronyssinus, Dermatophagoidespteronyssinus; D. farinae, Dermatophagoidesfarinae.

Fig. 3. The percentages of each fulfilled criterion of the (A) major features and (B) minor features of the diagnostic criteria. PHx, past history; FHx, family history.

Fig. 4. Proportion of the involved parts of the body according to different age groups.The age groups are defined as follows: infancy ≤2 years old, childhood and adolescence >2 years old and ≤18 years old, adulthood >18 years old.

Fig. 5. Association of severity and age. (A) The patients of different age groups stratified by EASI scores into mild, moderate, and severe groups. (B) The differences of EASI scores between adult patients with onset before adulthood and those with adultonset. The age groups were defined as follows: infancy ≤2 years old, childhood and adolescence >2 years old and ≤18 years old, and adulthood >18 years old.The EASI scores ranged from 0 to 72, with the scores stratified as follows: mild <7, moderate ≥7 and <21, and severe ≥21. EASI, eczema area and severity index. ^*P<0.01.

Fig. 6. (A) Comparison of EASI scores in male and female patients.(B)The association of totalIgE levels of different severity groups categorized by EASI scores. The EASI scores ranged from 0 to 72. The severity was stratified according to EASI scores as follows: mild <7, moderate ≥7 and<21, and severe ≥21. EASI, eczema area and severity index. ^*P<0.001.

Fig. 7. (A) Aggravating factors. (B) Aggravation of symptoms according to months of the year assessed by using a questionnaire.

Fig. 8. List of the treatments that the patients have received (A) in the past and (B) at our clinic.