| Objective:Understand the elderly atopic dermatitis patient’s clinical characteristics,including skin lesion distribution characteristics,lesion characteristics,clinical manifestation,and looking for elderly patients with total Ig E,eosinophil in peripheral blood,interleukin 4,and interleukin 17,explore the elderly atopic dermatitis and phenotypic similarities and differences between children and teenagers/adult.Methods:According to Hanifin & Rajka’s diagnostic criteria for atopic dermatitis,83 children(6≤ age < 12 years),107 adolescents/adults(12≤ age < 60 years),and 98 elderly patients(≥60 years)were selected from September 2020 to February 2022,and their clinical data were collected.Including the general situation,lesions distribution site,lesions characteristics,and characteristic clinical manifestations;the SCORAD score was used to score the severity of atopic dermatitis and collect venous blood.Only 62 cases were collected from adolescent/adult group,18 cases were mild(18.56 ± 4.342)and 44 cases were moderate severe(54.25 ± 16.651).Peripheral venous blood was collected from 98 patients in the elderly group,including mild 21(19.00±2.881)and moderate and severe 77(44.16±15.825).The serum levels of IL-4,IL-17,total Ig E,and eosinophil in patients with atopic dermatitis were statistically analyzed between the elderly group and the adolescent/adult group,and the correlation between each index and the severity of the disease was analyzed.Result:1.Distribution of AD lesions in the elderly: Compared with children,adolescents/adults,the lesions in the elderly group were distributed in the extensor part of limbs,accounting for the largest proportion(70.40%),and the difference was statistically significant(P < 0.05).Compared with the children group,skin lesions in the elderly group were less in the head and face(22.44%)and the elbow fossa/popliteal fossa(22.44%).In the children group,skin lesions in the head and face and the elbow fossa/popliteal fossa were54.21% and 48.19%,respectively.The differences were statistically significant(P < 0.05).2.Characteristics and characteristic clinical manifestations of AD lesions in the elderly: Compared with the children group,the proportion of epidermal exfoliation(67.3%),fibrosis(80.6%),and nodular prurigo(26.5%)in the AD group was significantly higher than that in the children group,and the difference was statistically significant(P < 0.05).In the elderly group,exudation/scab(29.6%),xeroderma(41.8%),per hair keratosis(7.1%),nipple eczema(9.2%),cheilitis(11.2%),suborbital fold(6.1%),periorbital black halo(8.2%),white pityriasis(7.1%),anterior cervical fold(20.4%),food allergy(16.3%),and white The proportion of scratch disease(5.1%),subauricular fissure(6.1%)and atopic disease history(27.6%)was significantly lower than that of children group,with statistical significance(P <0.05).Compared with the adolescent/adult group,the proportion of bryophytic lesions in the elderly group was as high as 80.6%,and the family and individual history of atopic diseases was less(27.6%),with statistically significant differences(P < 0.05).3.Comparison of the levels of total Ig E,EOS,IL-4,and IL-17 in peripheral blood of patients with different severity of AD in the elderly group: 21 cases with mild and 77 cases with moderate and severe AD.Moderate-severe group was significantly higher than mild group [total Ig E(354.11±249.96,195.37±122.89),EOS(0.92±0.48,0.58±0.46),IL-4(28.87±11.55,20.96±5.72),IL-17(32.69±15.86),20.93±9.63)],the differences were statistically significant(P < 0.05).4.Comparison of total Ig E,EOS,IL-4,and IL-17 levels in peripheral blood of AD patients with different severity in adolescent/adult group: 18 cases with mild and 44 cases with moderate and severe AD.Total Ig E(808.53±473.75,50.74±18.89),EOS(0.92±0.48,0.65±0.25),and IL-4(30.71±15.07,20.89±11.47)in moderate to the severe group were significantly higher than those in the mild group,the differences were statistically significant(P < 0.05).Il-17(26.04±8.72,22.43±6.93)showed no significant difference between moderate and severe groups(P = 0.123).5.Comparison of total Ig E,EOS,IL-4,and IL-17 levels in peripheral blood of AD patients with different severity in the elderly,adolescents,and adults: Total Ig E(354.11±249.96,808.53±473.75)in the elderly moderate-severe group was significantly lower than that in the adolescent/adult moderate-severe group(P < 0.05).Il-17(32.687 ± 15.862,26.044±8.721)in the elderly moderate-severe group was significantly higher than that in the adolescent/adult moderate-severe group(P < 0.05).There was no significant difference in IL-17 levels between the elderly group and the adolescent/adult group in patients with mild atopic dermatitis.There were no statistically significant differences in EOS and IL-4 in patients with different severity of AD in the elderly group and the adolescent/adult group.6.The relationship between total Ig E,EOS,IL-4 and IL-17 levels in peripheral blood of the elderly group and SCORAD score: Total Ig E(r=0.4736,P < 0.0006),EOS(R=0.5011,P < 0.0001),IL-4(r=0.7071,P < 0.0001),IL-17(r=0.7643,P < 0.0001)were positively correlated with SCORAD score in the elderly group.The level of IL-17 in peripheral blood of the elderly group was positively correlated with age(r=0.6168,P <0.0001).There was no correlation between THE level of IL-17 in peripheral blood of adolescent/adult group and SCORAD score(R =0.1153,P < 0.3724).Conclusion:1.AD lesions in the elderly are mostly distributed in the extensor and trunk parts of the limbs,and relatively few occur in the head and face,elbow fossa,and popliteal fossa.2.The morphology of AD lesions in the elderly is more characterized by epidermal exfoliation,mossy and nodular pruritus,and less crusted exudation.The lesions tend to be chronic eczema-like.3.There is less history of allergic reactions and atopic diseases in elderly AD,which means that external environmental factors may have little influence on the pathogenesis of elderly AD;The characteristic clinical manifestations of AD in the elderly are less than those in other age groups.4.The levels of total Ig E,EOS,IL-4,and IL-17 in peripheral blood of elderly patients with moderate and severe AD were significantly higher than those of patients with mild AD,and were positively correlated with the severity of the disease,which could be used as indicators to judge the severity of the disease.The level of IL-17 in peripheral blood of elderly AD was positively correlated with age,the level of IL-17 in peripheral blood of adolescents/adults with moderate and severe AD was not significantly different from that of patients with mild AD,and there was no correlation between the level of IL-17 in adolescents/adults with AD and the severity of the disease.Th2/Th17 skew exists in elderly AD. |
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