Abstract：
Atopic dermatitis (AD) is a chronic skin condition that can manifest in childhood and persist into adulthood or can present de novo in adults. The clinical presentation of adults with AD may differ among those with pediatric-onset versus adult-onset disease and potential differences between both groups remain to be better characterized. These atypical features might not be encompassed as part of current diagnostic criteria for AD, such as the Hanifin-Rajka (H-R) and the U.K. Working Party (UKWP) criteria. We conducted a retrospective chart review of the electronic medical records of a large, single, academic center to compare the clinical characteristics between adult-onset and pediatric onset AD and examine the proportion of patients who meet the H-R and/or UKWP criteria. Our single-center retrospective chart review included adults (≥ 18 years of age) with any AD-related ICD-10 codes, ≥ 2 AD-related visits, and a recorded physician-confirmed AD diagnosis. Descriptive statistics were used to compare adults with pediatric-onset (< 18 years of age) and adult-onset (≥ 18 years of age) AD. Logistic regression and x2 test were used to compare groups. We found that, compared to pediatric-onset AD, adults with adult-onset AD had less flexural involvement, flexural lichenification and a personal and family history of other atopic diseases. Compared to adults with pediatric-onset AD, adults with adult-onset AD had greater involvement of the extensor surfaces and more nummular eczema compared to pediatric-onset AD. In our cohort, adults with adult-onset AD were less likely to meet H-R and UKWP criteria compared to pediatric-onset AD. Adults with adult-onset AD may present with a clinical presentation that is different from those with pediatric-onset AD, which may not be completely captured by current AD criteria such as the H-R and UWKP criteria. This can lead to possibly mis- or underdiagnosing AD in adults. Thus, understanding the differences and working towards modifying criteria for adult-onset AD has the potential to improve accurate diagnosis of adults with AD.
摘要：
特应性皮炎（AD）是一种慢性皮肤病，可以在儿童期表现并持续到成年期，也可以在成人中从头出现。成人AD的临床表现在儿科发病与成人发病之间可能有所不同，两组之间的潜在差异仍有待更好地表征。这些非典型特征可能不作为当前AD诊断标准的一部分。例如Hanifin-Rajka(H-R)和英国工作组(UKWP)标准。我们对大型的电子病历进行了回顾性图表审查，单身,学术中心比较成人发病和儿童发病AD的临床特征，并检查符合H-R和/或UKWP标准的患者比例。我们的单中心回顾性图表审查包括患有任何AD相关ICD-10代码的成年人（≥18岁），≥2次AD相关访视，和记录的医生证实的AD诊断。描述性统计用于比较儿童发病（<18岁）和成人发病（≥18岁）AD的成人。组间比较采用Logistic回归和x2检验。我们发现,与儿科发病的AD相比，成人发病AD的成人弯曲受累较少，弯曲苔藓化以及其他特应性疾病的个人和家族史。与成人儿童发病AD相比，与儿童发病的AD相比,成人发病的AD患者伸肌表面受累更多,钱币状湿疹更多.在我们的队列中，与儿童发病AD相比,成人发病AD患者符合H-R和UKWP标准的可能性较小.成人发病型AD患者的临床表现可能不同于儿童发病型AD患者。当前的AD标准（如H-R和UWKP标准）可能无法完全捕获。这可能导致成人AD的诊断错误或诊断不足。因此，了解差异并努力修改成人发病AD的标准有可能提高成人AD的准确诊断。
