Atopic dermatitis (AD) usually presents during childhood and rarely in the elderly. AD is characterized by pruritus, erythematous papules, excoriations, lichenification and at times prurigo nodularis. It is also associated with other atopic diseases and elevated serum immunoglobulin E (IgE).

A 72 year-old woman developed diffuse pruritus 14 months prior to presentation. She developed worsening eczematous erythematous papules throughout her body with excoriations, which waxed and waned. Pruritus was intermittently controlled with hydroxyzine, a potent topical corticosteroid, and over-the-counter skin lotions. She denied any history of allergies or asthma.

Laboratory data were remarkable for blood eosinophils of 1896 cells/mcL, serum IgE of 7120 kU/L and mildly elevated IgE to multiple foods and environmental allergens such as egg white, peanut, ragweed, and dust mites. Skin biopsy revealed dermatitis with eosinophils consistent with AD. Immunohistochemical analysis for inflammatory cells was positive for CD4, CD8, and CD25; and negative to CD23, CD30, CD56, and CD57. One month later, with almost complete resolution of her skin lesions, blood eosinophils normalized to 480 cells/mcL but serum IgE had increased to 13540 kU/L. The patient continues to be monitored for development of disorders such as parapsoriasis, cutaneous T cell lymphoma or other lymphoproliferative disease.

Adult onset of AD with an extremely elevated serum IgE in an elderly individual without prior history of atopy may occur rarely.