There was once a time when atopic dermatitis was primarily considered a pediatric condition. However, new and robust data have shown that AD is now almost as common in adults over 60 as it is in children under 18.
In fact, aging alone may result in pathophysiologic changes that could trigger or worsen AD, according to a British Journal of Dermatology review published March 21, 2019.
Dr. Anna De Benedetto, assistant professor of dermatology at the University of Florida College of Medicine in Gainesville and her colleagues who conducted the review, noted that many age-related changes seem to overlap with key hallmarks observed in AD.
These include pruritis (itch), xerosis (dry skin), a decline in skin barrier function, dysregulation of the immune system and an increased risk of Staphylococcus aureus (staph) infection.
Evidence suggests environmental triggers, combined with a defective aged epidermal barrier, might contribute to the development or worsening of AD in elderly patients.
Specifically, seniors with AD tend to be more allergic to pollens and dust mites, and they often are hypersensitive to fragrance mixes and metals, such as nickel and cobalt.
Meanwhile, the reduction in the skin barrier function associated with getting older could exacerbate AD since aging skin has a harder time repairing itself compared to younger skin, the researchers pointed out.
In addition, the multiple changes that occur in an aging immune system can lead to a decreased ability to defend against pathogens, which would make older adults more vulnerable to severe and chronic infections.
As researchers do not yet fully understand the contributions of these immune system changes to AD onset or progression in the elderly, this may create challenges in treating elderly patients.
Further, the use of available AD treatment options can be impacted by the frequent presence of other age-related comorbid conditions in older patients, such as high blood pressure, diabetes, or osteoporosis.
The bottom line? More research is needed to address diagnostic concerns and treatment needs for senior AD patients as there are few clinical trials, research studies and care guidelines that focus specifically on adults over the age of 60.
The authors of the British Journal of Dermatology review concluded that understanding the distinct characteristics and needs of senior AD patients will be necessary as the worldwide elderly population continues to expand along with the rising number of AD cases.
NEA to fill missing gap in elderly AD research
Thanks to a NEA-funded grant, a team of researchers led by Dr. Katrina Abuabara, assistant professor of dermatology at the University of California San Francisco, are conducting an investigation to better understand eczema heterogeneity in older adults.
First, they hope to pinpoint potential drug triggers of AD to help clinicians identify which treatments should be discontinued among older adults with new-onset eczema or avoided by elderly patients with a history of eczema.
Secondly, they intend to conduct a pilot phenotyping study that would potentially recruit 25 adults over the age of 60, including 10 with a history of eczema since childhood, 10 newly diagnosed with eczema, and five controls who don’t have a history of skin disease.
Using state-of-the-art technology, the researchers would then collect blood samples and skin biopsies and perform detailed clinical assessments on these participants to gain a better understanding of the variability in underlying genetic, immune system and clinical profiles of eczema among older adults.
Knowledge gained from this pilot study would then support additional investigations, including future clinical trials, allowing researchers to develop and test treatments better suited to the unique needs of elderly patients.
“Our ultimate goals are to improve the diagnosis and treatment of eczema among older adults and to design prevention strategies to combat this growing epidemic,” Abuabara said.