BG03 Atopic eczema in older adults: findings from the UK-Irish Atopic eczema Systemic therapy Register (A-STAR)

Abstract

Atopic eczema is increasingly common in older adults, and real-world experience with systemic therapies is limited. We examined therapeutic choices and clinical patterns in adult patients with atopic eczema ≥ 60 years of age. Patients in A-STAR were stratified by age at enrolment (≥ 60 years, n = 69; 18 to < 60 years, n = 742; < 18 years, n = 336: this sequence used throughout) and age of drug initiation between October 2018 and November 2025. The χ2-test was used to assess the statistical significance of differences in characteristics among groups, with P-values < 0.05 considered statistically significant. Older adult patients with atopic eczema starting systemic therapy were predominantly male (65%, 54.0%, 57.1% in the three age groups) with a higher proportion with Fitzpatrick I/II skin type (62%, 59.4%, 44.9%) vs. V/VI (4%, 10.7%, 18.5%; P < 0.001). At drug initiation, the mean Eczema Area and Severity Index (17.0, 18.0, 21.8; P < 0.001), Dermatology Life Quality Index (14.0, 15.5, 14.0; P = 0.006) and Patient-Oriented Eczema Measure (18.8, 20.1, 18.7; P = 0.007) were significantly different among the age groups. Differences in clinical phenotype were confined to follicular eczema (1%, 8.5%, 16.5%) and ichthyosis (20%, 25.2%, 15.0%; P < 0.001). Allergic cophenomena also differed between groups: food allergy was less frequent (24%, 42.0%, 60.7%) and contact allergy more common in the older adults (44%, 38.6%, 12.8%; P < 0.001). The older adult cohort was more commonly exposed to at least two previous systemic treatments (58%, 54.0%, 35.6%; P < 0.001). Dupilumab (39%, 41.8%, 49.6%; P < 0.001) and methotrexate (13%, 17.0%, 26.5%) were utilized less in the older patients, while tralokinumab was more frequently prescribed (11%, 4.4%, 0.5%; P < 0.001). Overall, 13% of drug episodes in the older adult group were with Janus kinase inhibitors. When prescribing systemic treatment, comorbidities were considered more commonly (26%, 17.8%, 6.6%; P < 0.001), while the therapeutic profile determined treatment choice less often (19%, 29.5%, 43.0%). The clinical expression of atopic eczema in older adults is subtly different from that in younger groups. Significant differences in selected treatment regimens suggest consideration of cofactors by prescribers.