Comorbidities in Atopic Dermatitis


Atopic dermatitis (AD) is a chronic inflammatory skin condition with bothersome cutaneous symptoms. In addition, AD is known to lower quality of life, have a high disease burden, including increased emergency health care costs,1 and increase the risk for other chronic health conditions. 

A recent study, conducted by Jonathon I. Silverberg, MD, PhD, MPH, and colleagues, found significant associations between AD and multiple comorbidities, including atopic conditions, such as hay fever and asthma, as well as diabetes and cardiovascular disease.2 In addition, their study found direct and indirect relationships between AD severity and the risk of developing other chronic conditions. “Even mild AD was associated with an increased risk for asthma, hay fever, obesity, autoimmune disease, anxiety/depression, and other chronic conditions,” said Dr Silverberg, lead study author and associate professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, IL, in an interview with The Dermatologist.

Based on these findings, “patients with AD may benefit from increased screening for atopic diseases, depression, anxiety, obesity, diabetes, hypertension, and cardiovascular disease,” said Dr Silverberg. 

The Study

For the study,2 Dr Silverberg and his team obtained data from the Atopic Dermatitis in America survey. They assessed the data from the 2-stage sampling process to determine the prevalence of AD and to stratify individuals with AD by severity. In stage 1, 2173 participants were contacted and 1278 completed the online survey. In stage 2, 8217 participants were contacted. A total of 602 individuals with AD were identified based on the UK Working Party’s definition of AD. The AD cohort was stratified by severity into 1 of 4 groups: “none,” “clear/almost clear or clear/mild,” “moderate,” and “severe/very severe.”
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AD was assessed using the Patient Oriented Eczema Measure, Patient-Oriented Scoring of AD Index, and Dermatology Life Quality Index. In addition, comorbidities were reported by participants, which included ever-history of asthma and/or hay fever, 1-year history of food allergy, anxiety/depression, high blood pressure, diabetes, cardiovascular disease, autoimmune disease, other chronic diseases, and current obesity (defined using body mass index). Statistical analyses were used to examine the associations between AD and comorbid conditions and samples were weighted based on age, gender, race/ethnicity, education level, and household income, along with other demographics. 

The Findings

Overall, the prevalence of AD was 7.3%. Among the participants who reported AD severity, 289 (58.4%) reported mild AD, 172 (34.8%) moderate AD, and 34 (6.9%) reported severe AD. 

The researchers found that AD was associated with a significantly higher risk of asthma, hay fever, current obesity, 1-year history of food allergy, high blood pressure, diabetes, cardiovascular disease, autoimmune disease, anxiety/depression, and other chronic health conditions in bivariable models that adjusted for sociodemographic characteristics. “Patients with AD had higher odds of all of these comorbidities, all of which may increase AD patients’ morbidity and mortality,” said Dr Silverberg. However, this relationship is complex. Analyses showed that “some comorbidities, such as food allergy, anxiety, depression, and diabetes, appeared to be directly related to having moderate to severe AD,” said Dr Silverberg. “Other comorbidities, such as high blood pressure and cardiovascular disease were more common among moderate to severe AD patients but were indirectly related to these patients having increased anxiety/depression, obesity, and food allergy,” he added.

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