Background:

Adults with atopic dermatitis have had a persistent form in childhood or with an onset after the age of eighteen years. Late-onset atopic dermatitis may present with clinical heterogeneity and it often lacks the classic pattern of flexural dermatitis.

Clinical case:

A 26-year-old man with allergic rhinitis, with late-onset eczema, and an atypical nummular pattern on his trunk and limbs. The skin biopsy showed eczema-like lesions which, together with the patient’s personal history and laboratory abnormalities, allowed the diagnosis of the adult’s late-onset atopic dermatitis. Treatment with methotrexate was started and there was no response, which is why phototherapy was prescribed due to the dependence on systemic corticosteroids.

Conclusion:

Atypical presentations of atopic dermatitis in adults represent a clinical challenge. A personal history of atopy, sensitivity to aeroallergens, eosinophilia, and a cutaneous biopsy are essential to establish the diagnosis.

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