Atopic Dermatitis - It's Not Just Skin Deep

Atopic Dermatitis - It's Not Just Skin Deep Posted By:
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Atopic dermatitis (AD), or "eczema," is a common cutaneous disorder that most primary care clinicians see in their practices. However, many clinicians who are comfortable diagnosing the skin manifestations of AD may not be aware that it is more than skin deep. The most recent research demonstrates that AD is associated with numerous comorbidities. This is especially significant as the disease usually first manifests itself in infancy and early childhood.

Known comorbidities of AD include allergic asthma, hay fever, and food allergies. Patients with AD are also at a higher risk for developing other autoimmune conditions, such as inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and skin conditions such as vitiligo and alopecia areata. In addition, patients with AD have a higher risk of developing numerous psychosocial disorders including attention deficit/hyperactivity disorder, depression, anxiety, sleep disturbances, and suicidal ideation. Therefore, it is of paramount importance that patients with AD, regardless of age, have a multidisciplinary team to help manage their comorbidities, including their psychosocial needs.

The Dermatology Life Quality Index (DLQI) is a validated and widely accepted health-related questionnaire that focuses on quality of life, specifically for patients with skin conditions. It can open the door to discussing sensitive issues that a patient may not initially feel comfortable discussing, such as how embarrassed or self-conscious they may feel because of their skin condition. It may also enhance the therapeutic relationship between provider and patient, as well as contribute to increased treatment adherence and follow up. When used at different points in a patient's treatment regimen, the DLQI can also be useful in helping the practitioner assess a therapy's efficacy, not only regarding improvement in their skin, but also in their overall sense of well-being.

Understanding the cutaneous aspects of AD, as well as the myriad of associated comorbidities, can help the practitioner focus on the treatment goals of gaining clear to near-clear skin, minimizing the effects of comorbidities, and improving the patient's overall quality of life.

References
  • Eichenfield LF, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.
  • Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clinical and Experimental Dermatology. 1994;19:210-216.
  • Kage P, Simon J, Treudler R. Atopic dermatitis and psychosocial comorbidities. Journal of the German Society of Dermatology. 2020;18:93-102.
  • Na C, Chung J, Simpson E. Quality of life and disease impact of atopic dermatitis and psoriasis on children and their families. Children (Basel). 2019;6:E133.
  • Sidbury R, Kodama S. Atopic dermatitis guidelines: diagnosis, systemic therapy and adjunctive care. Clinical Dermatology. 2018;36:648-652.

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Filed under: Dermatology

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