Comorbidities & burden of disease in atopic dermatitis

Victor Gonzalez-Uribe,^1,2 Helena Vidaurri-de la Cruz,³ Andres Gomez-Nuñez,¹ Jordi A. Leyva-Calderon,¹ Zaira S. Mojica-Gonzalez⁴

Affiliations:
¹ Facultad Mexicana de Medicina, Universidad La Salle Mexico City, Mexico
² AlergiaMX, Dalinde Corta Estancia, Mexico City, Mexico
³ Pediatric Dermatology Service, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
⁴ Pathology, Molecular Biology, and Immunohistochemistry, Laboratorio Juarez, Mexico City, Mexico

Abstract

Background: Atopic dermatitis is associated with an increased frequency of other atopic & allergic manifestations, including asthma in 10% to 30% of cases depending on age, allergic rhinitis, food allergies, eosinophilic diseases, and allergic conjunctivitis. The comorbidities outside the atopic march are overall less frequent than in psoriasis.
Objective: This review aims to demonstrate the intense, broad burden of this disease, comorbidities and its multidimensional involvement as a complex, heterogeneous disease.
Methods: The present narrative review summarizes the findings from the world’s largest epidemiological studies and smaller, AD-specific studies on the comorbidities and burdens of this disease.
Results: The risk of asthma, specifically, and other atopic manifestations and skin infections, generally, is clearly increased among patients with AD. Of the other skin diseases, there is an undeniable risk of alopecia areata, vitiligo, and contact eczema and a lower risk of developing other autoimmune diseases. While comorbidities exist, their frequency seems to be modified by lifestyle, particularly by smoking. There is a link with overweight, obesity, and metabolic syndrome, especially in severe AD. This is also the case for cardiovascular diseases; however, with OR/HRs below 1.5. There is no link to type II diabetes but, rather, to type I in children. In all other areas, the data are often inconsistent, and any increase in risk is low. Eye diseases seem to be the only exception. AD also has psychiatric consequences, including attention-hyperactivity disorder, anxiety, depression, and sometimes suicidality, especially when severe.
Conclusions: The recently published work largely confirms our existing understanding of AD.
Key words: Atopic dermatitis, Comorbidity, Asthma, Allergic rhinitis, Vitiligo, Mental Health