Classical classification of atopic dermatitis according to the age range and topography of the lesions
Age range
Distribution or affected area
Infant phase (birth to 2 years old)
Eczematous lesions typically occur on the cheeks, forehead, scalp, and extensor surfaces
School phase (2 to 18 years old)
They occur on the flexor surfaces (antecubital fossae, popliteal fossae, neck, wrists, and ankles)
Adult phase (from 18 years old)
Lesions on flexor surfaces may persist, but they are classically associated with lesions in the head segment (the upper portion of the eyelids and lips)
Declarations
Acknowledgments
The authors would like to express their gratitude to AlergiaMx for providing all the necessary materials and the extensive knowledge that contributed to the development of this article.
Author contributions
VGU: Conceptualization, Methodology, Writing—original draft, Investigation. LAHZ: Data curation, Formal analysis, Visualization, Writing—review & editing. CAGN: Investigation, Resources, Data curation, Writing—review & editing. SNL and GMV: Writing—review & editing.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Langan SM, Mulick AR, Rutter CE, Silverwood RJ, Asher I, García-Marcos L, et al.; the Global Asthma Network Phase I Study Group. Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study.Clin Exp Allergy. 2023;53:337–52. [DOI]
Tian J, Zhang D, Yang Y, Huang Y, Wang L, Yao X, et al. Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study.Br J Dermatol. 2024;190:55–61. [DOI] [PubMed]
Reimer-Taschenbrecker A, Daniel M, Rangel SM, Paller AS. Do socioeconomic factors impact atopic dermatitis outcome? A single-center study.Pediatr Dermatol. 2023;40:1049–56. [DOI] [PubMed] [PMC]
Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease.Nat Rev Drug Discov. 2022;21:21–40. [DOI] [PubMed] [PMC]
Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment.Exp Dermatol. 2018;27:340–57. [DOI] [PubMed]
Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis.Int J Dermatol. 2020;59:e75–91. [DOI] [PubMed]
Kim DH, Li K, Seo SJ, Jo SJ, Yim HW, Kim CM, et al. Quality of life and disease severity are correlated in patients with atopic dermatitis.J Korean Med Sci. 2012;27:1327–32. [DOI] [PubMed] [PMC]
Siafaka V, Zioga A, Evrenoglou T, Mavridis D, Tsabouri S. Illness perceptions and quality of life in families with child with atopic dermatitis.Allergol Immunopathol (Madr). 2020;48:603–11. [DOI] [PubMed]
Ali F, Vyas J, Finlay AY. Counting the Burden: Atopic Dermatitis and Health-related Quality of Life.Acta Derm Venereol. 2020;100:330–40. [DOI] [PubMed] [PMC]
Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema.Int J Clin Pract. 2006;60:984–92. [DOI] [PubMed]
Silverberg JI. Comorbidities and the impact of atopic dermatitis.Ann Allergy Asthma Immunol. 2019;123:144–51. [DOI] [PubMed]
Gonzalez-Uribe V, Vidaurri-de la Cruz H, Gomez-Nuñez A, Leyva-Calderon JA, Mojica-Gonzalez ZS. Comorbidities & burden of disease in atopic dermatitis.Asian Pac J Allergy Immunol. 2023;41:97–105. [DOI] [PubMed]
Weidinger S, Novak N. Atopic dermatitis.Lancet. 2016;387:1109–22. [DOI] [PubMed]
Brown SJ, Elias MS, Bradley M. Genetics in Atopic Dermatitis: Historical Perspective and Future Prospects.Acta Derm Venereol. 2020;100:349–57. [DOI] [PubMed] [PMC]
Yamamura Y, Nakashima C, Otsuka A. Interplay of cytokines in the pathophysiology of atopic dermatitis: insights from Murin models and human.Front Med (Lausanne). 2024;11:1342176. [DOI] [PubMed] [PMC]
Ständer S. Atopic Dermatitis.N Engl J Med. 2021;384:1136–43. [DOI] [PubMed]
Ständer S, Simpson EL, Guttman-Yassky E, Thyssen JP, Kabashima K, Ball SG, et al. Clinical Relevance of Skin Pain in Atopic Dermatitis.J Drugs Dermatol. 2020;19:921–6. [DOI] [PubMed]
Kellogg C, Smogorzewski J. Update on Atopic Dermatitis.Adv Pediatr. 2023;70:157–70. [DOI] [PubMed]
Nutten S. Atopic dermatitis: global epidemiology and risk factors.Ann Nutr Metab. 2015;66:8–16. [DOI] [PubMed]
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: Results from an international survey.Allergy. 2018;73:1284–93. [DOI] [PubMed]
Silverberg JI, Barbarot S, Gadkari A, Simpson EL, Weidinger S, Mina-Osorio P, et al. Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study.Ann Allergy Asthma Immunol. 2021;126:417–28.e2. [DOI] [PubMed]
Croce EA, Levy ML, Adamson AS, Matsui EC. Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations.J Allergy Clin Immunol. 2021;148:1104–11. [DOI] [PubMed] [PMC]
Levin ME, Botha M, Basera W, Facey-Thomas HE, Gaunt B, Gray CL, et al. Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort.J Allergy Clin Immunol. 2020;145:415–26. [DOI] [PubMed]
Ofenloch RF, Schuttelaar ML, Svensson Å, Bruze M, Naldi L, Cazzaniga S, et al. Socioeconomic Status and the Prevalence of Skin and Atopic Diseases in Five European Countries.Acta Derm Venereol. 2018;99:309–14. [DOI] [PubMed]
Augustin M, Misery L, von Kobyletzski L, Mealing S, Redding M, Chuang CC, et al. Systematic literature review assessing the overall costs and societal impacts of moderate-to-severe atopic dermatitis in Europe.J Eur Acad Dermatol Venereol. 2022;36:2316–24. [DOI] [PubMed]
Ariëns LFM, van Nimwegen KJM, Shams M, de Bruin DT, van der Schaft J, van Os-Medendorp H, et al. Economic Burden of Adult Patients with Moderate to Severe Atopic Dermatitis Indicated for Systemic Treatment.Acta Derm Venereol. 2019;99:762–8. [DOI] [PubMed]
Mohr N, Augustin M, Zeervi L, Bieber T, Werfel T, Wollenberg A, et al. Determinants of costs and benefits in atopic dermatitis routine care in Germany.J Eur Acad Dermatol Venereol. 2022;36:1450–5. [DOI] [PubMed]
AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel; Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, et al.; Patient Groups: Global Parents for Eczema Research; Capozza K; National Eczema Association; Begolka WS; Evidence in Allergy Group; Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L; AAAAI/ACAAI Joint Task Force on Practice Parameters; Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations.Ann Allergy Asthma Immunol. 2024;132:274–312. [DOI] [PubMed]
Chovatiya R, Smith Begolka W, Thibau I, Silverberg J. Atopic Dermatitis Polypharmacy and Out-Of-Pocket Healthcare Expenses.J Drugs Dermatol. 2023;22:154–64. [DOI] [PubMed] [PMC]
Zimmermann M, Rind D, Chapman R, Kumar V, Kahn S, Carlson J. Economic Evaluation of Dupilumab for Moderate-to-Severe Atopic Dermatitis: A Cost-Utility Analysis.J Drugs Dermatol. 2018;17:750–6. [PubMed]
Ariëns LFM, Bakker DS, Spekhorst LS, Van der Schaft J, Thijs JL, Haeck I, et al. Rapid and Sustained Effect of Dupilumab on Work Productivity in Patients with Difficult-to-treat Atopic Dermatitis: Results from the Dutch BioDay Registry.Acta Derm Venereol. 2021;101:adv00573. [DOI] [PubMed] [PMC]
Frampton JE, Blair HA. Dupilumab: A Review in Moderate-to-Severe Atopic Dermatitis.Am J Clin Dermatol. 2018;19:617–24. [DOI] [PubMed]
Wollenberg A, Christen-Zäch S, Taieb A, Paul C, Thyssen JP, de Bruin-Weller M, et al.; European Task Force on Atopic Dermatitis/EADV Eczema Task Force. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children.J Eur Acad Dermatol Venereol. 2020;34:2717–44. [DOI] [PubMed]
Reynolds M, Gorelick J, Bruno M. Atopic Dermatitis: A Review of Current Diagnostic Criteria and a Proposed Update to Management.J Drugs Dermatol. 2020;19:244–8. [DOI] [PubMed]
Vakharia PP, Chopra R, Silverberg JI. Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials.Am J Clin Dermatol. 2018;19:15–22. [DOI] [PubMed]
de Bruin Weller MS, Rockmann H, Knulst AC, Bruijnzeel-Koomen CA. Evaluation of the adult patient with atopic dermatitis.Clin Exp Allergy. 2013;43:279–91. [DOI] [PubMed]
Wollenberg A, Schnopp C. Evolution of conventional therapy in atopic dermatitis.Immunol Allergy Clin North Am. 2010;30:351–68. [DOI] [PubMed]
Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, et al. English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021.J Dermatol. 2022;49:e315–75. [DOI] [PubMed]
Mengeaud V, Phulpin C, Bacquey A, Boralevi F, Schmitt AM, Taieb A. An innovative oat-based sterile emollient cream in the maintenance therapy of childhood atopic dermatitis.Pediatr Dermatol. 2015;32:208–15. [DOI] [PubMed]
Vieira BL, Lim NR, Lohman ME, Lio PA. Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review.Am J Clin Dermatol. 2016;17:557–81. [DOI] [PubMed]
Silverberg NB. Selected active naturals for atopic dermatitis: Atopic Dermatitis Part 1.Clin Dermatol. 2017;35:383–6. [DOI] [PubMed]
Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches.J Am Acad Dermatol. 2014;71:1218–33. [DOI] [PubMed] [PMC]
Edwards T, Felix K, Francois S, Cardwell L, Rice Z. Nonprescription Treatment Options. In: Feldman SR, Strowd LC, Lovell KK, editors. Management of Atopic Dermatitis: Methods and Challenges. Cham: Springer International Publishing; 2024. pp. 151–67. [DOI] [PubMed]
Chiricozzi A, Comberiati P, D’Auria E, Zuccotti G, Peroni DG. Topical corticosteroids for pediatric atopic dermatitis: Thoughtful tips for practice.Pharmacol Res. 2020;158:104878. [DOI] [PubMed]
Ellison JA, Patel L, Ray DW, David TJ, Clayton PE. Hypothalamic-pituitary-adrenal function and glucocorticoid sensitivity in atopic dermatitis.Pediatrics. 2000;105:794–9. [DOI] [PubMed]
Schlessinger J, Miller B, Gilbert RD, Plott RT; Vanos Study Group. An open-label adrenal suppression study of 0.1% fluocinonide cream in pediatric patients with atopic dermatitis.Arch Dermatol. 2006;142:1568–72. [DOI] [PubMed]
Friedlander SF, Hebert AA, Allen DB; Fluticasone Pediatrics Safety Study Group. Safety of fluticasone propionate cream 0.05% for the treatment of severe and extensive atopic dermatitis in children as young as 3 months.J Am Acad Dermatol. 2002;46:387–93. [DOI] [PubMed]
Hebert AA, Friedlander SF, Allen DB. Topical fluticasone propionate lotion does not cause HPA axis suppression.J Pediatr. 2006;149:378–82. [DOI] [PubMed]
Sidbury R, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies.J Am Acad Dermatol. 2023;89:e1–20. [DOI] [PubMed]
Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, et al.; American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents.J Am Acad Dermatol. 2014;71:327–49. [DOI] [PubMed] [PMC]
Kemény L, Varga E, Novak Z. Advances in phototherapy for psoriasis and atopic dermatitis.Expert Rev Clin Immunol. 2019;15:1205–14. [DOI] [PubMed]
Steyn M, Gerbens LAA, Spuls PI, Mashayekhi S, Deleuran M, Barbarot S, et al. Phototherapy for atopic dermatitis: A survey of European practice.J Eur Acad Dermatol Venereol. 2024;38:521–9. [DOI] [PubMed]
Mandlik DS, Mandlik SK. Atopic dermatitis: new insight into the etiology, pathogenesis, diagnosis and novel treatment strategies.Immunopharmacol Immunotoxicol. 2021;43:105–25. [DOI] [PubMed]
Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, et al. European guideline (EuroGuiDerm) on atopic eczema: part I – systemic therapy.J Eur Acad Dermatol Venereol. 2022;36:1409–31. [DOI] [PubMed]
Khattri S, Shemer A, Rozenblit M, Dhingra N, Czarnowicki T, Finney R, et al. Cyclosporine in patients with atopic dermatitis modulates activated inflammatory pathways and reverses epidermal pathology.J Allergy Clin Immunol. 2014;133:1626–34. [DOI] [PubMed] [PMC]
Kim K, Kim M, Rhee E, Lee MH, Yang HJ, Park S, et al. Efficacy and Safety of Low-Dose Cyclosporine Relative to Immunomodulatory Drugs Used in Atopic Dermatitis: A Systematic Review and Meta-Analysis.J Clin Med. 2023;12:1390. [DOI] [PubMed] [PMC]
Davis DMR, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies.J Am Acad Dermatol. 2024;90:e43–56. [DOI] [PubMed]
Ko KC, Tominaga M, Kamata Y, Umehara Y, Matsuda H, Takahashi N, et al. Possible Antipruritic Mechanism of Cyclosporine A in Atopic Dermatitis.Acta Derm Venereol. 2016;96:624–9. [DOI] [PubMed]
Armstrong AW, Huang A, Wang L, Miao R, Patel MY, Gadkari A, et al. Real-world utilization patterns of systemic immunosuppressants among US adult patients with atopic dermatitis.PLoS One. 2019;14:e0210517. [DOI] [PubMed] [PMC]
Ghamrawi R, Bell KA, Balogh EA, Strowd LC, Feldman SR. Current and emerging biologics for the treatment of pediatric atopic dermatitis.Expert Opin Biol Ther. 2020;20:1435–45. [DOI] [PubMed]
Nusbaum KB, Nguyen CM, Fleischer AB Jr. Emerging systemic therapies for atopic dermatitis: oral small molecules and targeted topical agents.J Dermatolog Treat. 2022;33:1274–8. [DOI] [PubMed]
Dubin C, Del Duca E, Guttman-Yassky E. The IL-4, IL-13 and IL-31 pathways in atopic dermatitis.Expert Rev Clin Immunol. 2021;17:835–52. [DOI] [PubMed]
Boyman O, Kaegi C, Akdis M, Bavbek S, Bossios A, Chatzipetrou A, et al. EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders.Allergy. 2015;70:727–54. [DOI] [PubMed]
Morita H, Matsumoto K, Saito H. Biologics for allergic and immunologic diseases.J Allergy Clin Immunol. 2022;150:766–77. [DOI] [PubMed]
Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB, Lee SE, et al. Targeted Molecular Therapies in Allergy and Rhinology.Otolaryngol Head Neck Surg. 2021;164:S1–21. [DOI] [PubMed]
Aranez V, Ambrus J Jr. Immunologic Adverse Effects of Biologics for the Treatment of Atopy.Clin Rev Allergy Immunol. 2020;59:220–30. [DOI] [PubMed]
Vultaggio A, Petroni G, Pratesi S, Nencini F, Cammelli D, Ferraro A, et al. How the immune system responds to therapeutic biological agents.J Int Med Res. 2016;44:38–42. [DOI] [PubMed] [PMC]
Matucci A, Nencini F, Pratesi S, Maggi E, Vultaggio A. An overview on safety of monoclonal antibodies.Curr Opin Allergy Clin Immunol. 2016;16:576–81. [DOI] [PubMed]
Muñoz-Bellido FJ, Moreno E, Dávila I. Dupilumab: A Review of Present Indications and Off-Label Uses.J Investig Allergol Clin Immunol. 2022;32:97–115. [DOI] [PubMed]
Paller AS, Siegfried EC, Thaçi D, Wollenberg A, Cork MJ, Arkwright PD, et al. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial.J Am Acad Dermatol. 2020;83:1282–93. [DOI] [PubMed]
Simpson EL, Paller AS, Siegfried EC, Boguniewicz M, Sher L, Gooderham MJ, et al. Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial.JAMA Dermatol. 2020;156:44–56. [DOI] [PubMed] [PMC]
Napolitano M, di Vico F, Ruggiero A, Fabbrocini G, Patruno C. The hidden sentinel of the skin: An overview on the role of interleukin-13 in atopic dermatitis.Front Med (Lausanne). 2023;10:1165098. [DOI] [PubMed] [PMC]
Silverberg JI, Guttman-Yassky E, Thaçi D, Irvine AD, Stein Gold L, Blauvelt A, et al.; ADvocate1 and ADvocate2 Investigators. Two Phase 3 Trials of Lebrikizumab for Moderate-to-Severe Atopic Dermatitis.N Engl J Med. 2023;388:1080–91. [DOI] [PubMed]
Wollenberg A, Blauvelt A, Guttman-Yassky E, Worm M, Lynde C, Lacour JP, et al.; ECZTRA 1 and ECZTRA 2 study investigators. Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Br J Dermatol. 2021;184:437–49. [DOI] [PubMed] [PMC]
Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment.Am Fam Physician. 2020;101:590–8. [PubMed]
Chovatiya R, Paller AS. JAK inhibitors in the treatment of atopic dermatitis.J Allergy Clin Immunol. 2021;148:927–40. [DOI] [PubMed] [PMC]
Huang IH, Chung WH, Wu PC, Chen CB. JAK-STAT signaling pathway in the pathogenesis of atopic dermatitis: An updated review.Front Immunol. 2022;13:1068260. [DOI] [PubMed] [PMC]
Hin Tang JJ, Hao Thng DK, Lim JJ, Toh TB. JAK/STAT signaling in hepatocellular carcinoma.Hepat Oncol. 2020;7:HEP18. [DOI] [PubMed] [PMC]
Nakashima C, Yanagihara S, Otsuka A. Innovation in the treatment of atopic dermatitis: Emerging topical and oral Janus kinase inhibitors.Allergol Int. 2022;71:40–6. [DOI] [PubMed]
Hu X, Li J, Fu M, Zhao X, Wang W. The JAK/STAT signaling pathway: from bench to clinic.Signal Transduct Target Ther. 2021;6:402. [DOI] [PubMed] [PMC]
Miot HA, Criado PR, de Castro CCS, Ianhez M, Talhari C, Ramos PM. JAK-STAT pathway inhibitors in dermatology.An Bras Dermatol. 2023;98:656–77. [DOI] [PubMed] [PMC]
Wan H, Jia H, Xia T, Zhang D. Comparative efficacy and safety of abrocitinib, baricitinib, and upadacitinib for moderate-to-severe atopic dermatitis: A network meta-analysis.Dermatol Ther. 2022;35:e15636. [DOI] [PubMed] [PMC]
Paller AS, Ladizinski B, Mendes-Bastos P, Siegfried E, Soong W, Prajapati VH, et al. Efficacy and Safety of Upadacitinib Treatment in Adolescents With Moderate-to-Severe Atopic Dermatitis: Analysis of the Measure Up 1, Measure Up 2, and AD Up Randomized Clinical Trials.JAMA Dermatol. 2023;159:526–35. [DOI] [PubMed] [PMC]
Blauvelt A, Teixeira HD, Simpson EL, Costanzo A, De Bruin-Weller M, Barbarot S, et al. Efficacy and Safety of Upadacitinib vs Dupilumab in Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial.JAMA Dermatol. 2021;157:1047–55. [DOI] [PubMed] [PMC]
Yang X, Kambe N, Takimoto-Ito R, Kabashima K. Advances in the pathophysiology of atopic dermatitis revealed by novel therapeutics and clinical trials.Pharmacol Ther. 2021;224:107830. [DOI] [PubMed]
Nakagawa H, Nemoto O, Igarashi A, Saeki H, Murata R, Kaino H, et al. Long-term safety and efficacy of delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with atopic dermatitis.J Dermatol. 2020;47:114–20. [DOI] [PubMed] [PMC]
Orfali RL, Aoki V. Blockage of the IL-31 Pathway as a Potential Target Therapy for Atopic Dermatitis.Pharmaceutics. 2023;15:577. [DOI] [PubMed] [PMC]
Kabashima K, Matsumura T, Komazaki H, Kawashima M; Nemolizumab-JP01 Study Group. Trial of Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus.N Engl J Med. 2020;383:141–50. [DOI] [PubMed]
