If you thought you dodged the eczema bullet in childhood, think again. This chronic skin condition, also called atopic dermatitis, doesn’t just impact kids. It can emerge unexpectedly in adulthood, catching many by surprise. In fact, a peak time for developing adult-onset eczema is in your 50s, according to the American Academy of Dermatology.
So, what triggers adult-onset eczema, and how does it differ from the condition in childhood? Megan Rogge, MD, a dermatologist at UT Physicians Dermatology – Bellaire Station, explained that the causes are not fully understood, but there are some leading theories.
“Typically, childhood eczema is due to genetic defects in a skin barrier protein called filaggrin,” said Rogge, an associate professor at McGovern Medical School at UTHealth Houston. “With adult-onset, these individuals also may have the genetic defect, but environmental triggers don’t bring it out until they’re older.”
What triggers eczema?
Stress, climate change, increased exposure to skin irritants, and dry skin can all contribute to the sudden onset of eczema in adulthood. Rogge said our skin becomes drier as we age and loses its normal lipid barrier.
Hormonal changes also can play a role, according to Rogge. Lower estrogen levels can affect skin barrier function and lower the threshold for external factors to trigger eczema.
“Another theory is that adult-onset eczema is totally different from childhood-onset eczema, and the causes are not the same,” Rogge said. “For some unknown reason, the immune system is having a reaction that triggers the condition.”
Symptoms of eczema
Eczema symptoms can be mild to severe, including dry, cracked skin, itchiness, and a rash on swollen skin that can ooze and crust. The itching often causes sleep loss.
Adult eczema may appear on the head, neck, hands, or feet rather than the classic areas in children, such as the folds of their elbows and knees. Rogge also notes that nummular eczema, which is coin-shaped, is more common in adults.
Diagnosing the condition
Little information is published regarding adult-onset eczema, even though 1 in 4 adult patients with eczema report it started after age 18. The most challenging aspect of adult-onset eczema can be the diagnosis because the presentation differs from childhood eczema. Ruling out other potential causes, such as skin allergy, can make the diagnostic process more complex and time-consuming for adults.
Make it go away
Moderate to severe cases of adult-onset eczema can affect quality of life, causing some individuals to avoid social activities due to their appearance. It also can affect their mental health.
Despite the challenges, effective treatments for adult-onset eczema are available. Rogge recommends the same gentle skin care approach used for childhood eczema — avoid harsh soaps, hot water, and excessive friction or exfoliation. Topical steroids and other topical medications are often the first line of treatment.
For more severe cases, light therapy, immunosuppressant drugs, and biologic medications such as dupilumab (Dupixent) can provide relief. Rogge says dupilumab “is a game changer for eczema treatment across the board” for both childhood and adult-onset forms.
Managing eczema long term
While the prognosis for adult-onset eczema is less clear, Rogge notes that many patients do respond well to treatment. However, some may require long-term management to keep the condition under control.
The key is working closely with a dermatologist to develop an effective treatment plan and manage this misunderstood form of atopic dermatitis. With proper care, adults with sudden-onset eczema can find relief and regain their quality of life.
