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Atopic dermatitis

About: There is a growing amount of scientific literature on the associations between skin disease and psychological morbidities that affect patients’ overall mental health and well-being. In this series, we spotlight the mental health burdens of skin conditions.

Fast Facts About Atopic Dermatitis

  • Atopic dermatitis (AD) is a common, chronic, and inflammatory skin disease characterized by (1) persistent itch, (2) recurrent eczematous lesions, and (3) varying stages, all of which are driven by both inflammatory and neuronal mechanisms1–3
  • AD is a heterogeneous skin disorder, and patients with AD may present with different phenotypes and severity concerning itch and skin lesions, varying from mild to severe4
  • Itch is the most burdensome symptom of the disease, and severe pruritus accompanied by scratching and subsequent excoriations, bleeding, or the formation of hemorrhagic crusts are hallmark features of AD1,5
  • Patients with AD may experience a chronic fluctuating disease course, including a dormant phase with no acute AD symptoms. However, chronic scratch-related lesions, including lichenification, can persist even during the dormant stage of the disease1,2

The Mental Health Burden of Atopic Dermatitis

AD is associated with a heavy mental health burden in patients and is the source of the leading cause of burden from skin disorders globally.6 Moderate to severe AD profoundly impairs patients’ quality of life, leading to low self-esteem, social isolation, embarrassment about appearance, and an increased likelihood of suicidal ideation compared to healthy individuals.2,5,7,8 One study found one hundred percent of patients with severe AD show elevated levels of anxiety and depression9.

In addition, many suffer from sleep disturbances due to severe itch, which can affect mental and psychological well-being.8,9  

The currently available systemic treatments for AD show some improvements in signs and symptoms, but many patients with AD do not achieve symptom relief, and their needs remain unmet.10–12

Addressing Mental Health Issues

Addressing mental health challenges and providing a comprehensive treatment plan is important for managing AD. Advising patients with AD to participate in therapy programs is one effective way to provide the mental health support this population needs.13 Evidence shows that patients who participated in a 12-week therapy program had fewer flare-ups and eczematous symptoms than those who did not participate. 14 Encouraging patients to meditate and practice mindfulness exercises and teaching them effective stress management strategies may also help them overcome some mental challenges they face.13

Atopic dermatitis is a complex and challenging disease, and patients’ mental and emotional well-being are important aspects of the disease that clinicians need to address.


  1. Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12):1136-1143. doi:10.1056/NEJMra2023911
  2. Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017;23(suppl 8):S115-S123
  3. Illi S, von Mutius E, Lau S, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol. 2004;113(5):925-931. doi:10.1016/j.jaci.2004.01.778
  4. Chovatiya R, Lei D, Ahmed A, Chavda R, Gabriel S, Silverberg JI. Clinical phenotyping of atopic dermatitis using combined itch and lesional severity: a prospective observational study. Ann Allergy Asthma Immunol. 2021;127(1): 83-90.e2. doi:10.1016/j.anai.2021.03.019
  5. Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019;123(2):144-151. doi:10.1016/j.anai.2019.04.020
  6. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-1534. doi:10.1038/jid.2013.446
  7. Halvorsen JA, Lien L, Dalgard F, Bjertness E, Stern RS. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Invest Dermatol. 2014;134(7):1847-1854. doi:10.1038/jid.2014.70
  8. Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol. 2015;135(1):56-66. doi:10.1038/jid.2014.325
  9. Silverberg JI, Gelfand, JM, Margolis DJ, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554-565. doi:10.1111/bjd.17683
  10. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327-349. doi:10.1016/j.jaad.2014.03.030
  11. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335-2348. doi:10.1056/NEJMoa1610020
  12. Nezamololama N, Fieldhouse K, Metzger K, Gooderham M. Emerging systemic JAK inhibitors in the treatment of atopic dermatitis: a review of abrocitinib, baricitinib, and upadacitinib. Drugs Context. 2020;9:2020-8-5. doi:10.7573/dic.2020-8-5 
  13. Can seeing a therapist help with eczema? Healthline. Updated April 13, 2022. Accessed September 2, 2022.
  14. Hedman-Lagerlöf, E., Fust, J., Axelsson, E., Bonnert, M., Lalouni, M., Molander, O., Agrell, P., Bergman, A., Lindefors, N., & Bradley, M. (2021). Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis: A Randomized Clinical Trial. JAMA dermatology, 157(7), 796–804.

*Expert author(s), speaker(s) or contributor(s) where indicated are paid Galderma consultants.

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