Clinical differences between atopic and atopiform dermatitis

Elian E. A. Brenninkmeijer, Phyllis I. Spuls, Catharina M. Legierse, Robert Lindeboom, J. Henk Sillevis Smitt, Jan D. Bos

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Abstract

BACKGROUND: Atopic dermatitis (AD) has been divided into the "extrinsic" and "intrinsic" type, in which "intrinsic AD" is characterized by the absence of allergen-specific IgE. Still, there is no consensus whether this "intrinsic type" of AD, which we denominate as atopiform dermatitis (AFD), is a distinct entity. OBJECTIVE: A case-control study was performed to compare the clinical and diagnostic features of AD and AFD. METHODS: Patients with a clinical diagnosis of AD were selected. Cases did not have demonstrable allergen-specific IgE. Matched control subjects were tested positive for allergen-specific IgE. Patients were evaluated for medical history, quality of life, disease severity, and Hanifin and Rajka, U.K. and Millennium diagnostic criteria. RESULTS: Eight percent (n = 34) of the selected patients had, in fact, AFD. Female predominance, absence of atopic diseases, later onset of disease, and milder disease severity were observed in AFD. A history of atopy, recurrent conjunctivitis, palmar hyperlinearity, keratosis pilaris, pityriasis alba, and hand and/or food eczema were significantly less present in AFD. Dennie-Morgan fold was positively associated with AFD. LIMITATIONS: Not all patients with negative allergen-specific IgE participated and a relatively small number of AFD patients were studied. CONCLUSIONS: In addition to the absence of allergen-specific IgE, our findings support that AFD is an entity distinct from AD. With a distinction shown between AFD and AD, patient groups will be better defined and more homogeneous. Implications of this distinction will be of importance for preventive and therapeutic advice; diagnostic processes; and for future research
Original languageEnglish
Pages (from-to)407-414
JournalJournal of the American Academy of Dermatology
Volume58
Issue number3
DOIs
Publication statusPublished - 2008

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