Olecranon and pretibial bursitis in atopic dermatitis: Coincidence or association?

Background: Bursal fluid accumulations are not usually associated with skin disease; however, several cases have been observed in a large atopic dermatitis (AD) clinic. Objective: We sought to characterize the clinical features of bursitis in AD and to assess the evidence for a mechanistic association between these conditions. Methods: We retrospectively evaluated the clinical presentation of bursitis in six adults with lifelong severe AD. The course of the bursitis and possible causative factors were assessed for each patient. Results: Ten episodes of bursitis were documented in six patients with chronic active AD. Two cases initially appeared as pretibial bursal fluid accumulations, a type of bursitis that is previously undescribed. Onset of bursitis in all cases coincided with flaring of dermatitis. The frequency of these 10 episodes in six patients among an AD population of 792 appears to be greater than the three cases per 1000 in the local Veterans Administration outpatient center. Conclusion: The unusual pretibial bursal fluid accumulations in AD, along with multiple recurrences of olecranon bursitis during flares of dermatitis, suggest that the association may not be coincidental.