Dr Robert Sidbury Summarizes Updated Atopic Dermatitis Guidelines at AAD 2022

Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, sat down to discuss comorbidities newly associated with atopic dermatitis (AD) at the 2022 American Academy of Dermatology (AAD) Annual Meeting.

Transcript

What are some comorbidities now associated with atopic dermatitis that are included in the 2022 AAD Atopic Dermatitis Management Guidelines?

We've had comorbidities that we've known about forever, such as the so-called atopic triad—asthma, food allergies, allergic rhinitis—those are also included in these guidelines. But the newer ones that are a little bit less well known are, for instance, things like bone issues, osteoporosis fractures. That's been a bit of a surprise, and maybe it shouldn't be. Probably multifactorial: is it due to steroid use? Is it due to something else? But that was one.

Probably the one that's most significant, in my own personal opinion—this is not expressed in the guideline—is the issue of depression and anxiety, because obviously that's a huge issue. This document that's been published so far has to do with adults. I see just kids [as a pediatric dermatologist], but that issue of depression and anxiety, risk of suicidal ideation, the association with depression anxiety is associated, was how we labeled that. Association with suicide was less strong because the evidence was less strong. But either way, that's just an important thing to be aware of and to address appropriately within the context of your own experience and your own patient population.

Otherwise, things that were relatively new and quite intriguing were the cardiovascular outcomes. Things like hypertension, associated things like dyslipidemia or obesity, those are important. One of our speakers in the session [Friday], Dr. [Jonathan] Silverberg, who's done a lot of this work himself, referenced atopic dermatitis as a systemic disease. That, for many, is almost a non sequitur, but we are really starting to think of it that way, just like we are starting to think of psoriasis the same way. They're skin manifestations, but there's inflammation that's systemic that can have systemic implications.

Finally, there were things that were less strong in the adult population, like ADHD [attention-deficit/hyperactivity disorder]. That's a stronger literature in the pediatric population, my world, but important to remember, because that's one where you can have a clinical sense of what's going on with a patient and have a really ready explanation. For instance, in my world, kids who are losing focus, have inattention, aren't able to pay attention at school: they have eczema, they're losing sleep, they're tired. Well, maybe they have a separate diagnosis, ADHD, that's treated differently and that would be an important thing to untangle. Same thing with adults; if they're having difficulty at work, staying focused, etc., maybe it's because they're losing sleep with their bad eczema, maybe it's something separate.

Those are, in a nutshell, the ones that I, from a high-level thinker, are worth covering here today, but there were others as well, so I think that document is worth reading.