Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders

Amy Paller; Jennifer C. Jaworski; Eric L. Simpson; Mark Boguniewicz; John J. Russell; Julie K. Block; Susan Tofte; Jeffrey D. Dunn; Steven R. Feldman; Adele R. Clark; Gene Schwartz; Lawrence F. Eichenfield

Disclosures

Am J Clin Dermatol. 2018;19(6):821-838. 

In This Article

Abstract and Introduction

Abstract

The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.

Introduction

Atopic dermatitis (AD), a common chronic inflammatory skin disease in children and adolescents, impacts the quality of life of patients and their families, and has become a global health issue.[1] Patients with AD are at a slightly, but significantly, increased risk of all-cause mortality compared with the general population.[2,3] The association between AD and food allergy, asthma, and allergic rhinitis as part of the so-called 'atopic march' has been the subject of several recent reviews.[4,5] It has been well established that AD is also associated with an increased risk of allergic contact dermatitis, hand dermatitis, and irritant contact dermatitis.[6–8] Much less attention, however, has been given to the risk of non-allergic comorbidities of AD, which include cutaneous and extra-cutaneous infections, neuropsychiatric conditions, and emerging comorbidities, such as obesity, cardiovascular disease, and some cancers. Most of these comorbidities affect children, while others occur during adulthood in patients with long-standing disease, supporting the systemic nature of AD[9,10] and suggesting that measures during childhood to reduce disease severity could protect against the development of these comorbidities.

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