[Late-onset atopic dermatitis with nummular pattern].

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.