Atopic dermatitis is a disease that has been increasing in recent decades. It usually presents in childhood, however the prevalence of the disease in adolescents and adults has been increasing (8, 15). Data on the prevalence of AD in these populations is scarce, with very few studies describing the age of onset, behavior, and frequency of the disease at these ages (8). Our study included children and adults with a diagnosis of atopic dermatitis; of the total population evaluated, only 32.2% were younger than 18 years of age. In 65.1% of the patients evaluated, the age of symptom onset was before 2 years of age. Comparing data from the literature and our data, we can highlight that the frequency of the disease in adults is significant, as well as the relevance of the age of onset in this population and the frequency of persistence of the disease that started in childhood (16).
Recent studies suggest that there is considerable heterogeneity in the age of onset of AD, highlighting the fact that 1 in 4 adults with AD report that their disease began in adulthood (17). Our study had a predominance of adult patients, in which the most frequent location of the lesions were the flexural folds and extensor surfaces, in contrast to populations younger than 18 years, in which the most frequent location included both extensor surfaces and the face. In the literature we found that AD in adulthood is associated with higher rates of plantar dermatitis, lower predominance of lesions in flexural areas and lower rates of other characteristic signs (17, 18).
This makes diagnosis more difficult at this age, increasing the difficulty in distinguishing AD from other entities such as allergic contact dermatitis and cutaneous T-cell lymphoma (18). The development of the disease or its persistence associated with the severity of AD in adults jeopardizes productivity and the rate of labor insertion (19). The severity and complications of AD may be associated with the tendency to develop skin infections, which in our study was present in 14.7% of the population evaluated. These infections usually begin in a focal area of the skin but can spread rapidly and cover extensive areas of the body surface. It is important to be able to differentiate severe exacerbation from AD which may have more generalized cutaneous signs and symptoms such as erythema, swelling, oozing and tenderness, all of which can also be signs of skin infections (16). Given the impact of AD on patients' quality of life. We found that in the patients evaluated there was a significant decrease in the DLQI value at the end of follow-up. Considering that the good control of the disease is not only influenced by the adequate selection of therapies, but also by the multidisciplinary management of these patients and the capacity to respond to any complication. The evaluation of underlying psychiatric disorders helps to improve the quality of life of patients, achieving greater adherence to therapies and better response rates to the established treatments. There is emerging evidence suggesting that AD is associated with depression and anxiety (20). Some 30–60% of patients with dermatologic disease have some type of mental health problem (18). In a case-control study exploring routinely collected data from the UK Clinical Practice Research Datalink, a significantly increased risk of depression as well as anxiety incidence in patients with AD was demonstrated (18, 21).
Our study reveals a prevalence of psychiatric disorders in up to 7.3% of the total population under evaluation, a figure notably lower compared to other studies where frequencies of up to 18.8% have been documented. The lower incidence of psychiatric disorders observed in our study may be attributed to several factors. Firstly, our patient follow-up program lacks the involvement of medical specialists in psychiatry. Additionally, when referrals to health insurance companies are made, the availability of specialists in this field is limited, resulting in lengthy waiting times for appointments. Furthermore, the absence of standardized employment of psychiatric evaluation scales during assessments hampers the detection of such pathologies (22).
This agrees with reports in the literature, which highlight that obesity is one of the comorbidities defined as a risk factor for AD and has also been associated with more severe disease. However, the specific mechanisms that explain the connection between obesity and AD are not yet fully recognized (23, 24). Obesity is known to be a metabolic disorder that often manifests early in life and is associated with reduced bacterial diversity in the gastrointestinal tract. Several lines of evidence suggest that obesity increases the severity of allergic diseases. Obese patients with immune diseases such as atopy and asthma have more severe disease compared to lean individuals (24). The identification of these risk factors and the intervention to correct them is of great importance for the adequate control of symptoms in patients with atopic dermatitis. The results of our study coincide with the literature, showing that topical therapy including emollients, topical steroids and calcineurin inhibitors are the most frequently used combinations of therapy with a percentage of 91% in the evaluated population. Systemic therapies are the first option in severe AD, the selection of these therapies is made based on the severity of the disease and according to previous therapies received. The use of biologic therapy is indicated in patients with severe clinical and quality of life impairment. Among the biologic products, dupilumab is authorized in other countries for children from 6 months of age and in Colombia from 6 years of age (25).
Oral JAK inhibitors, such as baricitinib, abrocitinib and upadacitinib, have been approved in adolescents when other drugs, including biologics, have failed, or are contraindicated (13). Data on the use of these biologic therapies or others such as crisaborole were not included in the study, as they were approved after the recruitment dates of the study patients. It is crucial to understand the characteristics of a disease in children and adults for a complete and personalized management. It is important to know data such as age of onset, symptoms, location of common lesions according to age, comorbidities, and responses to treatments. This information is essential for choosing appropriate therapies, ensuring effective follow-up, and improving quality of life. The participants of this study constitute a representative cohort of patients with atopic dermatitis followed in a health institution specialized in the management and control of immune-mediated diseases. The availability and use of biologic drugs has expanded treatment options for patients with moderate to severe AD, particularly for those who have not achieved satisfactory results with conventional therapies or who have contraindications to systemic immunosuppressive agents. These drugs provide a more targeted and personalized approach, reducing symptoms, improving quality of life and preventing long-term complications associated with uncontrolled disease as we see in the results.
Limitations
Although important and complete information is shown for a significant number of patients with AD, we consider that the follow-up time was short, which limits the evaluation of the effect of the therapy or the use of other therapies. Most of the patients belong to the contributory health care system; we do not know information on the characteristics and behavior of the population in other socioeconomic spheres, where probably the lack of access to this type of programs may show a greater severity of symptoms and a limitation in the use of therapies for the control of the disease. Since the clinical histories are not pre-tabulated, there were variables with few data, other data do not appear since the study was retrospective. The prevalence of psychiatric disorders related to the disease was low; we suggest the implementation of screening scales for these pathologies to assess their impact on the severity of the disease. It is important given the frequency of these reported in the literature that they be included in the follow up evaluation by psychiatry.