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Does atopic dermatitis always start in childhood?

Atopic Dermatitis

My experience is that the vast majority of adults with atopic dermatitis have adult onset atopic dermatitis. Now, I was trained in residency that atopic dermatitis always starts in childhood, is always flexural, and is always associated with strong personal history of atopy. None of those things are true. Whenever you look at the AAD census criteria, which I think are fantastic, it's itchy, it's chronic, it's spongiotic, it spares the groin and axilla if it has those four characteristics, and it's not allergic contact dermatitis, it's not scabies, it's not sebraic dermatitis, it's not psoriasis, it's not any of those other things that we can easily rule out. So really, it becomes that atopic dermatitis is your default diagnosis for everyone with spongiotic dermatitis, unless it involves a groin and axilla or you are certain that there's some other type of dermatitis. So, again, does it always start in childhood? No. And in fact, my experience is, in adults, the vast majority of people who meet the criteria had no history of childhood dermatitis at all. In a purely adult onset disease.

Does atopic dermatitis always start in childhood?

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