Comorbidities Associated With Atopic Dermatitis Journal of Allergy and Clinical Immunology

TAKE-HOME MESSAGE

• This review discusses both atopic and non-atopic comorbidities in patients with atopic dermatitis (AD). The prevalence of autoimmune diseases has been consistently shown to be higher in patients with AD. Atopic comorbidities and conjunctivitis are very common in patients with AD. Patients with AD have an increased risk of suicidality, anxiety, and depression. The association between AD and cardiovascular disease and cancer is less clear.
• Comorbidities of AD are common and should be considered when prescribing newer systemic treatments.

–  Kelly B. Scarberry, MD

Written by

 

 

Sheilagh Maguiness MD

Atopic dermatitis (AD) is extremely common, occurring in up to 20% of children in the US and persisting in up to 5% of adults. Atopic comorbidities associated with AD are well known and include asthma, allergic rhinitis, and food allergies, as well as a tendency for contact sensitization and hand dermatitis. There has been growing evidence to support that the presence of AD may lead to non-atopic comorbidities, of which mental health aspects, ocular conditions, autoimmune diseases, and infection are emerging as likely associations.

In this review article, the authors consolidate recent large, systematic review studies looking at both atopic and non-atopic comorbidities of individuals with AD. They caution readers to carefully consider the statistical analyses, being mindful of the difference between Relative and Absolute Risk, as the way in which these are reported can skew interpretation and lead to overemphasizing their impact. Even if their overall impact is relatively minor, improved understanding of the comorbidities of individuals with AD will lead to improved, and hopefully more holistic patient care.  

After synthesizing the evidence, the authors found that the non-atopic comorbidities most highly associated with AD included infectious and ocular comorbidities, as well as psychiatric and autoimmune ones. Regarding infectious comorbidities, atopic patients have impaired cell-mediated immunity and are more prone to viral and bacterial infections. In addition, authors also reported increased risk for other infections such as strep pharyngitis and urinary tract infections. Eye findings in patients with AD are frequently observed, independent of treatment with IL4,13 monocolonal antibody use. Ocular comorbidities included conjunctivitis, blepharitis, and dry eye. The psychiatric impact of AD is not to be underestimated, as depression, anxiety, and suicidality are all increased across age ranges in patients with AD. The risk for autoimmune disease is also elevated: alopecia areata risk is increased 10 fold in patients with AD, but in addition, other autoimmune diseases like vitiligo, chronic urticaria, celiac disease, inflammatory bowel disease, systemic lupus, and inflammatory arthritis, are also more common in individuals with AD. Osteoporosis was found to be a comorbidity of AD, with the caveat that this association could be due to confounding factors such as corticosteroid use and vitamin D deficiency, still, it is an important consideration in our patient population. Finally, cardiovascular disease and cancer risks were only slightly elevated in patients with AD and most likely due to contributing factors such as smoking, and/or immunosuppressive medications like cyclosporine.

This "review of reviews" is a useful framework for education in our atopic patient population. Dermatologists often see their patients with chronic AD on a more frequent basis than their primary care providers. This study lays out the areas for further questioning and rationale for referral to other health care teams as appropriate. The more we learn about inflammatory skin disease, the more we realize how interconnected and complex these disease states truly are.

Abstract 

Atopic dermatitis (AD) is a common disease that is associated with atopic and nonatopic comorbidities. There has been a growing interest in this area of AD, because presence or risk of comorbidities can in many ways impact the management of patients with AD. Thus, some treatments for AD may improve its comorbidities as well, whereas others may increase their risk. In this review article, we discuss various comorbidities of AD mostly on the basis of the results of recent multiple systematic reviews and meta-analyses to update readers about this rapidly developing area of dermatology. We emphasize the important information provided by studies presenting both relative risk and absolute risk, and show that AD is associated with, among others, atopic comorbidities such as asthma, rhinitis, and food allergy, nonatopic comorbidities such as ocular, psychiatric, infectious, endocrine, autoimmune, and cardiovascular diseases, and certain cancers. Clinicians need to be aware of these and be cognizant about positive and negative effects of existing and new treatments for AD.

Journal of Allergy and Clinical Immunology

Comorbidities of atopic dermatitis-what does the evidence say?

J. Allergy Clin. Immunol 2023 Jan 06;[EPub Ahead of Print], JP Thyssen, AS Halling, P Schmid-Grendelmeier, E Guttman-Yassky, JI Silverberg 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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