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. 2021 Mar 26:12:20406223211002979.
doi: 10.1177/20406223211002979. eCollection 2021.

Nomenclature and clinical phenotypes of atopic dermatitis

Giampiero Girolomoni  1 , Marjolein de Bruin-Weller  2 , Valeria Aoki  3 , Kenji Kabashima  4 , Mette Deleuran  5 , Luis Puig  6 , Ashish Bansal  7 , Ana B Rossi  8
Affiliations

Nomenclature and clinical phenotypes of atopic dermatitis

Giampiero Girolomoni et al. Ther Adv Chronic Dis. .

Abstract

Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term 'atopic dermatitis' rather than eczema, because it describes the allergic background and inflammation ('itis') as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.

Keywords: atopic; dermatitis; eczema; nomenclature; phenotype; treatment.

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Conflict of interest statement

Conflict of interest statement: Dr. Giampiero Girolomoni has been principal investigator in sponsored clinical trials and received personal fees from AbbVie, Abiogen, Almirall, Amgen, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, LEO Pharma, Lilly, Menlo Therapeutics, Merck, Merck Sharp & Dohme, Novartis, OM Pharma, Pfizer, Regeneron, Samsung, Sandoz, Sanofi Genzyme and UCB Pharma. Dr. Marjolein De Bruin-Weller has been principal investigator, advisory board member, and consultant for Regeneron, Sanofi Genzyme; principal investigator, and advisory board member for AbbVie, Pfizer, and Leo Pharma; and advisory board member for Lilly, UCB, Galderma, and Janssen. Dr. Valeria Aoki has received honoraria for lecturing from Sanofi. Dr. Kenji Kabashima has received consulting fees, honoraria, grant support, and lecturing fees from Japan Tobacco, LEO Pharma, Maruho, Mitsubishi Tanabe, Ono, Procter & Gamble, Sanofi, Taiho, and Torii. Dr. Mette Deleuran has received research support, honoraria for lecturing and is on consulting/advisory board agreements with AbbVie, Almirall, Galapagos, LEO Pharma, Lilly, Meda Pharma, Pfizer, Pierre Fabre, Regeneron, and Sanofi Genzyme. Dr. Luis Puig has received research support, honoraria for lecturing, and is on consulting/advisory board agreements with AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, LEO Pharma, Lilly, Merck Serono, Merck Sharp & Dohme, Pfizer, Mylan, Novartis, Roche, Sandoz, Samsung Bioepis, Sanofi, and UCB. Dr Puig is also an Associate Editor of Therapeutic Advances in Chronic Disease and, therefore, the peer review process was managed by alternative members of the Board and the submitting Editor had no involvement in the decision-making process. Dr. Ashish Bansal is an employee and shareholder of Regeneron Pharmaceuticals, Inc. Dr. Ana B. Rossi is an employee and may hold stock and/or stock options in Sanofi Genzyme.

Figures

Figure 1.
Figure 1.
Clinical signs of atopic dermatitis.
Figure 2.
Figure 2.
Morphologic phenotypes. (a) Nummular (discoid) dermatitis. (b) Prurigo nodularis. (c) Erythrodermic. (d) Lichenoid dermatitis. (e) Follicular/papular dermatitis. (f) Dyshidrosis or Pompholyx.
Figure 3.
Figure 3.
Topographic phenotypes of AD. (a) Typical flexural dermatitis. (b) Face. (c) Eczematous cheilitis. (d) Eyelid dermatitis. (e) Head and neck dermatitis. (f) Hand dermatitis. (g) Nipple dermatitis. †Inadequate treatment of eyelid dermatitis can lead to severe chronic inflammation with scarring or ‡ocular surface diseases such as atopic keratoconjunctivitis (picture shows sclerosis and symblepharon of conjunctiva).
Figure 4.
Figure 4.
Atopic dermatitis: histology. (a) Normal skin. (b) Atopic dermatitis. (c) Dyshidrosis. (d) Acute dermatitis. (e) Chronic dermatitis.
Figure 5.
Figure 5.
Histology: subacute chronic dermatitis, psoriasiform dermatitis. (a) Sub-acute-chronic dermatitis. (b) Psoriasiform dermatitis. Histological images generously provided by Dr Maria Teresa Fernández-Figueras.
Figure 6.
Figure 6.
Most common phenotypes of hand eczema: dyshidrotic and hyperkeratotic. (a) Dyshidrotic eczema. The main component of dyshidrotic eczema is the presence of multiple vesicles containing clear fluid; the hands are usually wet. Sometimes due to the thick stratum corneum, vesicles do not come out of the skin surface and are only visible on close examination. (b) Hyperkeratotic eczema. Features include skin thickening (hyperkeratosis), fissures and bleeding, desquamation, and scaling. The hands are usually very dry.
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