Clinical and morphological characteristics of atopic dermatitis phenotypes
Averkin N.S., Orlova E.I., Lisenkova M.A., Kandrashkina Yu.A., Larionova V.A.
Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant clinical and pathogenetic heterogeneity. Adult forms of AD are particularly variable, lacking clear diagnostic criteria, complicating diagnosis verification and treatment planning. The purpose of this review is to systematize current understanding of the clinical and morphological phenotypes of adult AD, including nummular, follicular, prurigo-like/pruriginous AD, as well as hand AD, nipple eczema, and dermatitis of the head and neck.
Methods: An analysis of Russian and international sources indexed in PubMed, Scopus, Web of Science, and eLibrary for the period 2021–2026 was conducted. Selection criteria included original studies and review articles on the clinical phenotypes of AD, skin pathology, and genetic and immunological mechanisms of disease development.
Results: The review systematizes the characteristics of various forms of AD. In the nummular form, foci of spongiosis with lichenoid infiltration and a mixed Th2/Th17/Th22 profile are detected. Follicular AD is characterized by perifollicular acanthosis and hyperkeratosis without spongiosis. The prurigo-like (pruriginous) form is characterized by epidermal hyperplasia, dermal fibrosis, and high IL-31 expression. Pompholyx is characterized by spongiosis around the eccrine ducts with expression of IL-1 and IL-31. Nipple eczema is characterized by acanthosis, parakeratosis, and lichenification in the areola. Head and neck dermatitis is associated with a Th2 response and Malassezia colonization.
Conclusion: The data presented in this review suggest the need for phenotyping AD, taking into account its morphological and pathogenetic characteristics. This can serve as the basis for a differentiated approach to therapy, allowing for optimization of treatment depending on the predominant disease mechanism.
For citations: Averkin N.S., Orlova E.I., Lisenkova M.A., Kandrashkina Yu.A., Larionova V.A. Clinical and morphological characteristics of atopic dermatitis phenotypes. Pharmateca. 2026;33(5):6-12. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.5.6-12
Authors’ contribution: All authors contributed equally to the conception, design, data analysis, and writing of the manuscript.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Keywords
atopic dermatitis
classification
pathogenesis
morphology
About the Authors
Nikita S. Averkin, Cand. Sci. (Med.), Associate Professor, Department of Morphology, Medical Institute, Penza State University, Penza, Russia; averkin.n@list.ru, ORCID: https://orcid.org/0000-0001-8129-9400Ekaterina A. Orlova, Dr. Sci. (Med.), Associate Professor, Head of the Department of Allergology and Immunology with a Course in Dermatovenereology and Cosmetology, Penza Institute for Advanced Medical Training – Branch of the Russian Medical Academy of Continuous Professional Education, Penza, Russia; lisaorl@yandex.ru, ORCID: https://orcid.org/0000-0002-3902-2018 (corresponding author)
Mariya A. Lisenkova, Student, Medical Institute, Penza State University, Penza, Russia; mar_lisenkova@mail.ru, ORCID: https://orcid.org/0009-0002-8486-7316
Julia A. Kandrashkina, Cand. Sci. (Med.), Associate Professor, Associate Professor at the Department of Obstetrics and Gynecology, Medical Institute, Penza State University, Penza, Russia; novikova10l@mail.ru, ORCID: https://orcid.org/0000-0002-5537-5729
Valeria A. Larionova, Assistant Professor, Department of Morphology, Medical Institute, Penza State University, Penza, Russia;
larionova.valeria.workakk@yandex.ru, ORCID: https://orcid.org/0000-0002-7864-1524
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