Elderly Atopic Dermatitis Cases Up 85% in the US Since 1990, New Study Shows

Cases of elderly atopic dermatitis (AD) increased by 85.53% among oldest-old adults within the US from 1990-2019, according to new research published in Clinical & Experimental Allergy. Researchers also reported mixed gender-related disparities among such patients, with higher age-specific rates of prevalence among men and cases among women.1

Elderly AD is a newly defined subtype of AD observed in people aged 60 years and older and is characterized by unique clinical features, according to researchers. “Unlike adolescent/young adult AD, unaffected folds of the elbows and knees are more common, and lichenified eczema surrounding the folds is frequently observed in the flexure and extensor sites of the extremities in elderly AD,” first author Minmin Wang, from the Department of Global Health at the Peking University School of Public Health in Beijing, and colleagues wrote.1

“In the present study, we aimed to evaluate the sex disparities in prevalence and influencing factors among the US oldest-old adults,” Wang and colleagues wrote.1 “Our findings may provide valuable insights for the management of elderly AD among this population.”

The researchers analyzed adults aged 80-84, 85-89, 90-94, and 95 years and older. They assessed US-based prevalence data on AD between 1990 and 2019, with the information collected from the Global Burden of Disease (GBD) 2019 study.2

Investigators assessed rates of AD prevalence as well as the number of disease cases, exploring the epidemiologic profile of AD among this older population. They also projected future trends from 2020 - 2030 using a Bayesian age-period-cohort model. The analysis examined trends over time by various factors such as calculated male-to-female case ratios and sex, and used age-period-cohort modeling stratified by sex to isolate the impacts on the results of timeframe, age, and birth cohort on shifts in the disease's prevalence. Quantification of the roles of population growth, aging, and prevalence rate shifts in driving the rise in AD cases was done using Das Gupta's decomposition method, according to the study.1

Results showed that between 1990 - 2019, the number of disease cases in the oldest-old age cohort rose by 85.53%, with a larger absolute and relative increase being identified among men—126.09% compared to 63.39% in women. Wang and colleagues noted that the forecasts suggest continuation of this upward trend, with approximately 467 700 estimated cases by 2030.1

In all of the evaluated age brackets, women were shown to have made up the majority of cases, with the team highlighting male-to-female case ratios ranging from 0.40 - 0.85. This pattern was highlighted by the research team as a “high-female case disparity," although there has been a gradual reduction in the sex gap since 1990.1

The age-standardized prevalence rate (ASPR) for AD as of 2019 in this elderly cohort was 2471.79 per 100 000 patients. From 1990 to 2019, there was an increase in ASPR at an average annual rate of 0.14%, with men reporting a slightly quicker rise (0.13% per year) compared to the 0.08% per year increase among women.1

Men showed consistently higher rates of disease prevalence across all 4 age groups, with male-to-female prevalence rate ratios showing a range from 1.10 - 1.45. This “high-male rate disparity" was more pronounced in the older age groups, according to the study.1

“Clinically, the higher number of elderly female AD cases highlights the need for specialized treatment and care tailored to women, necessitating the involvement of more dermatologists,” researchers concluded.1 “Public health initiatives should aim to address the higher prevalence rate among elderly males by implementing male-specific education programs that focus on improving skin care knowledge, etc.”

References:

1. Wang M, Cao X, Zhou M, Mi Y, Yu P, Guo Y. Mixed sex disparities in elderly atopic dermatitis prevalence among US oldest-old adults: A longitudinal study. Clin Exp Allergy. Published online April 20, 2025. doi:10.1111/cea.70060
2. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204-1222. doi:10.1016/S0140-6736(20)30925-9