Clinical Features And Risk Factors Of Senile Atopic Dermatitis

ObjectiveTo understand the demographic characteristics and related risk factors of senile atopic dermatitis,and to explore the clinical characteristics of senile atopic dermatitis(lesion distribution,inducing or aggravating factors,correlation scale scores),laboratory examination and treatment status.MethodsClinical data of 102 non-elderly patients with eczema-like dermatitis(HC),285 elderly patients with AD(age ≥60),95 adolescents/adults with AD(12≤ age < 60),and 93 children with AD(0≤ age < 12)admitted to Guangdong Dermatology Hospital from June 2021 to January 2023 were collected.This includes general information,age of onset,family history of atopic disease,lifestyle habits,predisposition or aggravation factors,site of lesions,SCORAD score,dermatosis life quality index,sleep disturbance score,pruritus score,laboratory examination,treatment.The demographic characteristics and related risk factors of AD in the elderly were analyzed,and the differences in clinical characteristics,laboratory examination and treatment between AD in the elderly and AD in children,adolescents/adults were analyzed.Results1.Demographic characteristics and risk factors of elderly AD: compared with healthy control group,elderly AD had higher proportion of abnormal absolute value of peripheral blood eosinophilia in gender,town of residence,habit of bathing,habit of hot washing,and lower proportion of abnormal absolute value of peripheral blood eosinophilia when bathing time was controlled within 5-10 minutes,the difference was statistically significant(P < 0.05).Male sex,hot washing habit and abnormal EOS in peripheral blood were independent risk factors for AD in old age.2.Comparison of inducing/aggravating factors in the elderly,adolescents/adults and children with AD: compared with adolescents/adults and children with AD,hot water washing(23.86%)in the elderly with AD induced/aggravating diseases was higher;The proportion of elderly AD scratching(67.02%)induced/aggravated disease was higher than that of adolescents/adults.Compared with AD in children,the proportion of mental factors induced/aggravated(15.44%)diseases in elderly AD was higher,and the proportion of food induced/aggravated diseases was lower(14.39%),the difference was statistically significant(P < 0.05).3.Distribution characteristics of skin lesions in elderly AD: Compared to AD for adolescents/adults and children,Elderly AD in scalp(45.26%),the forehead(34.74%),after the neck(38.60%),hips(45.26%),upper arm stretched out side(76.49%),forearm stretch side(89.82%),thigh stretch side(58.95%),legs stretched out side(90.88%)(76.14%),knee,elbow and place(65).96%),wrist extension(74.39%)had a higher proportion of skin lesions,and cheek(37.54%)had a lower proportion of skin lesions;Compared with adolescent/adult AD,the incidence rate of AD in the elderly was higher in the anterior chest(62.46%)and wrist flexor(64.56%).Compared with AD in children,the incidence of AD in old people was higher in the back of hands(48.07%)and back of feet(38.60%).The incidence of skin lesions was lower in perioral(4.21%),flexion side of upper arm(44.21%),flexion side of forearm(69.47%),flexion side of thigh(43.16%),flexion side of lower leg(78.95%),fossae cubis(48.77%)and flexion side of leg(36.14%),and the difference was statistically significant(P < 0.05).4.Comparison of pruritus,sleep and quality of life in the elderly,adolescents/adults and children AD group: Compared with adolescents/adults and children AD,the quality of life index of skin diseases in the elderly AD was lower(9.01±4.04);Compared with children,AD affected sleep degree score(NRS)of5.98±2.69 in the elderly was lower.Compared with adolescent/adult AD,the skin disease life quality index(13.94±3.32),pruritus degree score(7.04±1.21)and sleep degree score(7.51±1.97)in children AD were higher,and the differences were statistically significant(P < 0.05).5.Compared with adolescents/adults and elderly AD,the proportion of peripheral blood EOS in children AD was lower in the normal range(0-0.52)and higher in the abnormal range(> 0.52).Compared with adolescents,adults and children with AD,the proportion of Ig E values in the range of 100 to 1000 is higher in the elderly AD,and the proportion in the range of > 2500 is lower.The difference was statistically significant(P< 0.05).6.Current treatment status of AD in the elderly: Compared with adolescent/adult and child AD,the proportion of elderly AD treated with tripterygium wilfordii(27.02%),traditional Chinese medicine(46.32%),methotrexate(40.35%),first-generation antihistamines(60.70%)was higher,and the proportion treated with external PDE-4inhibitor(Creborol)(2.11%)was lower.Compared with adolescent/adult AD,the proportion of the elderly AD treated with JAK inhibitor(1.4%),sodium thiosulfate +albuminate 2(66.67%)was lower.Compared with children AD,the proportion of second-generation antihistamines(98.6%),central sensitization inhibitors(gabapentin,pregabalin)(55.79%),narrow-spectrum UVB(12.63%)and systemic hormones(28.75%)in elderly AD was higher.The proportion of topical calcineurin inhibitors(tacrolimus,pimeclimus)(16.84%)and biologic agents(duprilizumab)(10.53%)were lower,and the difference was statistically significant(P < 0.05).Conclusion1.The independent risk factors of AD in the aged were male,hot water washing habit and abnormal EOS in peripheral blood.The factors that induce or aggravate AD in the aged are scratching,hot water washing and mental factors.2.In elderly AD,skin lesions occur in the extended side of limbs,front chest,back neck,scalp,forehead,buttocks and other parts,and are relatively few in the flexion side of limbs,cheeks,and around the mouth.It is proved that AD in old age does exist "reversal" sign.3.Serum Ig E(100-1000)was higher in the laboratory test of AD in the elderly.The life quality index of dermatosis was relatively low;The degree of pruritus and the degree of sleep influence are lower than that of AD in children,which means that AD in the elderly is different from AD in other ages and is its special manifestation.4.In terms of treatment,immunosuppressants(such as tripterygium and methotrexate)and first-generation antihistamines were used more frequently in elderly AD,while new drugs(such as topical PDE-4 inhibitors,oral JAK inhibitors and biologic agents)were used less.