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 mechanisms^1–3
• 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 AD^1,5
• 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 disease^1,2

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.

References

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. https://www.healthline.com/health/atopic-dermatitis/can-seeing-a-therapist-help-with-eczema
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. https://doi.org/10.1001/jamadermatol.2021.1450