Atopic Dermatitis Associated With Frequent Cutaneous Comorbidity

atopic dermatitis
Woman checking the hand with very dry skin and deep cracks
Cutaneous comorbidity is frequent in those with atopic dermatitis, suggesting the need for comprehensive, dermatologically guided diagnostics.

The significant prevalence of cutaneous comorbidity among patients with atopic dermatitis (AD) was demonstrated by study data published in the Journal of the European Academy of Dermatology and Venereology.

Investigators abstracted data from skin screenings performed at more than 400 companies in Germany between 2006 and 2017. Trained dermatologists administered full-body examinations to employees who elected to participate; all demographic and clinical findings were documented in an electronic database. Prevalence ratios (PRs) were calculated to compare comorbidities in employees with and without current AD. Current AD was diagnosed if the patient presented with clinical signs at the time of skin check. Logistic regression analyses were performed to identify any associations between current AD and other skin conditions.

A total of 118,939 employees were examined during the 12-year study period, among whom 43.2% were women. The mean (standard deviation) age was 43.2 (10.7) years. Current AD was identified in 1.45% of participants; self-reported lifetime prevalence of AD was 4.95%. Employees with current AD had significantly higher prevalence rates of hand eczema (PR, 4.62), contact dermatitis (PR, 3.38), exsiccation dermatosis (PR, 2.19), folliculitis (PR, 1.95), and port wine stains (PR, 1.49) compared with employees without AD. Aside from preexisting conditions, the most common comorbidities among patients with current AD were folliculitis (19.53%) and port wine stains (3.07%). After adjustments for age, sex, and skin type, AD was significantly associated with hand eczema (odds ratio [OR], 3.96; 95% CI, 2.95-5.32), contact dermatitis (OR, 2.97; 95% CI, 1.50-5.88), folliculitis (OR, 2.03; 95% CI, 1.77-2.32), exsiccation dermatosis (OR, 1.78; 95% CI, 1.30-2.44), and port wine stains (OR, 1.45; 95% CI, 1.10-1.92).

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Psoriasis, however, was a significant negative predictor for AD (OR, 0.61; 95% CI, 0.39-0.94). Although the association of AD and other atopic conditions is well documented, “[T]here is need for further exploration on the negative correlation of atopic dermatitis and psoriasis,” the researchers wrote. “From the clinical point of view, the concurrent occurrence of these two entities in fact seems to be rare.”

The methodology of data collection implies limitations, as data were collected in the course of skin screenings in corporate environments. This could imply selection effects resulting from the different morbidity profile of the working population compared with unemployed people: the “healthy worker” effect. In addition, the study population might be selected as a result of the voluntary nature of the screenings.

Cutaneous comorbidity appeared frequently in patients with current AD, underscoring the necessity of comprehensive diagnostics in dermatology. The use of a working population for study increases the generalizability of these results.

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Zander N, Augustin M, Reinert R, Schäfer I. Atopic dermatitis shows significant cutaneous comorbidity: results from large-scale investigations in the working population [published online July 13, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15792