The Gray Area: A Challenging Case of AD in an Older Patient

Mr George Johnson is a 68-year-old retired preschool teacher who presents a persistent pruritic rash, and a history of recurrent cardiovascular events, including a myocardial infarction 2.5 years ago. He reports a history of atopic dermatitis that has been relatively well controlled until recently; the itching has become more irritating, and he reports sleep disturbances as a result.

Atopic eczema on the knee with clear excoriations and lichenification. Image courtesy of DermNet

Physical examination reveals tractable facial erythema and lateral eyebrow shedding (Hertoghe’s sign). Lichenification is evident on extended sides of the elbows and knees. The patient's skin appears generally dry.