Higher Risk of Systemic, Psychiatric Conditions Found in Patients With Atopic Dermatitis

US adults with atopic dermatitis (AD) may be at greater risk of psychiatric, autoimmune, and systemic comorbidities than the general population, according to study findings published in the Journal of the American Academy of Dermatology.

AD, which has been identified as the leading cause of disability among skin conditions, is characterized by a complex etiology that shares systemic implications. Notably, studies investigating the comorbidity burden in patients with AD have focused mostly on inpatient populations, despite the condition being primarily seen in the ambulatory population.

“There is a need to better characterize AD and its comorbidities in a more representative, real-world setting to better guide counseling and management of patients with AD,” said the study authors.

Examining an ambulatory population derived from the MarketScan Commercial Claims and Encounters database between January 1, 2017, and December 31, 2017, researchers conducted a retrospective analysis to better characterize the real-world comorbidities present in AD populations.

In the study, the comorbidity burden of adult patients with AD (n = 39,779; mean [SD] age, 42.5 [13.7] years; 63.9% female) was compared with age- and sex-matched controls from the general population (n = 353,743) via multivariable logistic regressions.

Compared with the control group, patients with AD exhibited an extensively greater risk of comorbidities overall:

• Psychiatric conditions: obsessive-compulsive disorder (odds ratio [OR], 2.01), schizophrenia (OR, 1.45), anxiety (OR, 1.44), attention-deficit hyperactivity disorder (OR, 1.43), eating disorder (OR, 1.33), and mood disorder (OR, 1.31).
• Infectious conditions: methicillin-resistant Staphylococcus aureus (OR, 3.92), herpes virus (OR, 2.24), HIV (OR, 2.00), Helicobacter pylori (OR, 1.70), and influenza (OR, 1.38).
• Autoimmune diseases: alopecia areata (OR, 6.01), vitiligo (OR, 4.44), dermatopolymyositis (OR, 3.54), systemic lupus erythematosus (OR 2.46), connective tissue disease (OR, 2.34), and Sjögren syndrome (OR, 2.17).
• Systemic conditions: atherosclerosis (OR, 1.69), chronic obstructive pulmonary disease (OR, 1.52), metabolic syndrome (OR, 1.47), hyperlipidemia (OR, 1.37), chronic kidney disease (OR, 1.28), and sleep disorders (OR, 1.52)

Increased risk of oncologic, dermatologic/allergic, and neurologic/ocular conditions, as well as other comorbidities of the aforementioned disease types, was also identified in patients with AD compared with the general population.

Several limitations were noted regarding the study findings, including its retrospective study design and use of health care claims data that prevented controlling for other potential confounders, such as ethnicity, race, and AD severity.

“Real-world, ambulatory adults with AD were associated with a wide range of psychiatric, dermatologic, and extracutaneous comorbidities, highlighting the systemic nature of this disease,” they concluded. “Increased awareness of the comorbidity burden and modifiable risk factors in AD can help guide 311 effective counseling, workup, and management of these patients.”

Reference

Roh YS, Huang AH, Sutaria N, et al. Real-world comorbidities of atopic dermatitis in the U.S. adult ambulatory population. J Am Acad Dermatol. Published online November 17, 2021. doi:10.1016/j.jaad.2021.11.014