Though atopic dermatitis (AD) is relatively uncommon in the elderly, elderly patients with AD are gradually increasing in industrialized countries associated with an aging society. Therefore, the clinical features of senile AD are becoming more apparent in some aspects. Three patterns of onset-senile onset, recurrence of AD with a history of classic childhood AD, and recurrence or continuation of adult AD-are associated with AD in the elderly. A male predominance in elderly AD may be a characteristic feature that differs from adult AD. Localized lichenifications in the folds of elbows and knees that are typical of classic AD are uncommon. Similar to AD in the other age groups, both extrinsic and intrinsic forms of AD exist in the elderly, and the major environmental allergens in the extrinsic form are house dust mite, followed by pollens and foods. In addition to the clinical features, this review focuses on the pathogenesis, diagnosis, management and future directions of this new subgroup of AD.