Severe Atopic Dermatitis Tied to Poor Mental Health

Patients with atopic dermatitis (AD) have fluctuating symptoms of depression over time, and those with severe AD have the highest risk for depressive symptoms, investigators reported in a study published the Journal of the American Academy of Dermatology.

The longitudinal study included patients aged 18 years or older with AD enrolled from an eczema clinic at an academic medical center from 2013 to 2020.

The participants were assessed at baseline and had follow-up visits every 6 months. They received standards of care throughout, including emollients, topical and systemic medications, and phototherapy. Self-administered electronic surveys, including the Patient Health Questionnaire (PHQ)-9, were completed before their visit.

A total of 695 adult patients (64% women) were included, with a mean ± SD age at enrollment of 44.2 ± 17.2 years and a mean ± SD age of AD onset of 19.93 ± 23.44 years.

At baseline, 65.32% of participants had minimal PHQ-9 scores, 20.00% had mild PHQ-9 scores, 8.20% had moderate PHQ-9 scores, 3.88% had moderately severe PHQ-9 scores, and 2.59% had severe PHQ-9 scores.

At the second follow-up visit, the percentage of participants with minimal depression (n = 127 [69.02%]) or moderate depression (n = 19 [10.33%]) increased, the percentage with moderately severe depression was similar (n = 8 [4.35%]), and the percentage with mild (n = 36 [17.48%]) and severe (n = 2 [1.09%]) depression decreased vs baseline.

Among the patients who had 2 or more follow-up visits, 45.65% had persistence of depression severity, 4.89% had sustained improvement, and 49.46% had fluctuation of depression severity classification over time. Fluctuation of depressive symptoms was the highest in those with baseline moderate (80.00%) PHQ-9 scores.

Difficulty concentrating was the most persistent individual depressive symptom over time. Trouble sleeping was associated with the greatest improvement over time and also had the greatest percentage of fluctuation over time. Severe Eczema Area and Severity Index score had the strongest association with difficulty concentrating over time (adjusted odds ratio [95% CI], 7.622 [3.881-14.968]).

The predictors of worse depression over time, according to bivariable models, included age older than 65 years (β [95% CI], 0.330 [0.082-0.579]); Hispanic, African American, and other non-White race (0.312 [0.171-0.454]), (1.739 [1.591-1.887]), and (-1.184 [-1.277 to -1.091]), respectively; male sex (0.838 [0.659-1.017]); and patients with Medicaid, Medicare, and uninsured/self-pay (3.880 [3.539-4.221]), (1.226 [0.901-1.550]), and (-1.005 [-1.440 to -1.091]), respectively.

Multivariable models found that disease characteristics of worse depression over time included mild and moderate facial erythema, mild and moderate nipple eczema, and moderate and severe itch, as well as pain, nights of sleep disturbance, and mild pityriasis alba.

Study limitations include the enrollment of patients from a single academic center and lack of formal evaluation and management by a mental health specialist. In addition, the impact of family history of AD or specific treatment on mental health was not assessed.

“These results suggest that AD manifests with symptoms of depression that wax and wane over time together with the cutaneous signs and symptoms of disease,” concluded the researchers. “Based on the results of this study, we recommend that patients with AD be routinely monitored for depressive symptoms.”

Disclosure: This research was supported in part by Galderma. Some of the study authors declared affiliations with a pharmaceutical company. Please see the original reference for a full list of disclosures.

Reference

Chatrath S, Lei D, Yousaf M, Chavda R, Gabriel S, Silverberg JI. Longitudinal course and predictors of depressive symptoms in atopic dermatitis. J Am Acad Dermatol. Published online May 10, 2022. doi:10.1016/j.jaad.2022.04.061