Atopic dermatitis and eczema, nail diseases, and hair loss are significantly associated with depression in children and adolescents, researchers reported in the Journal of Affective Disorders.

The retrospective case-control study enrolled children and adolescents diagnosed with depression for the first time in 185 pediatric practices in Germany from January 2017 to December 2019, and matched control participants without depression. Data were obtained from the Disease Analyzer database. The analysis included 9 skin conditions—atopic dermatitis and eczema, urticaria, nail disorders, hair loss, acne, rosacea, pigmentation disorders, epidermal thickening, and atrophic disorders of the skin.

A total of 7061 children and adolescents with depression and 7061 matched control participants without depression were included (mean [SD] age, 11.3 [3.8] years; 53.4% girls, for both groups). Among the participants with depression, approximately 4.7% had mild depression, 16.5% had moderate depression, 2.6% had severe depression, and the others (76.3%) had undefined depression.


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Regression analysis showed that atopic dermatitis and eczema (odds ratio [OR], 1.50; 95% CI, 1.37-1.64), nail disorders (OR, 1.84; 95% CI, 1.20-2.82), and hair loss (OR, 1.84; 95% CI, 1.30- 2.60) were significantly associated with depression.

Sex-stratified regression analysis demonstrated that atopic dermatitis and eczema (OR, 1.43; 95% CI, 1.26-1.61) and hair loss (OR, 2.04; 95% CI, 1.37-3.03) were significantly associated with depression among women patients, and atopic dermatitis and eczema were associated with depression (OR, 1.58; 95% CI, 1.39-1.80) in men patients. In addition, a strong nonsignificant association was observed for nail disorders (OR, 2.07; 95% CI, 1.07-4.01) and pigmentation disorders (OR, 1.93; 95% CI, 1.05-3.54) in women participants.

The study has several limitations, according to the investigators. Diagnoses of depression and other disorders were based on ICD-10 codes, and no information was available regarding the duration or intensity of the respective illness or location of the skin lesions. Data were also lacking for potential confounders such as socioeconomic status, social support, and psychosocial stressors.

“One important factor that is common to all associated conditions is a possible impact on the external appearance of the patient, especially due to skin lesions affecting the face, head, or hands,” the researchers commented. “This physical change and environmental reactions to it can cause low self-esteem, feelings of embarrassment, and depression in young people, as they are in a critical phase of development during which they are likely to compare themselves to others.”

Reference

Teichgräber F, Jacob L, Koyanagi A, Shin JI, Seiringer P, Kostev K. Association between skin disorders and depression in children and adolescents: a retrospective case-control study. J Affect Disord. 2021;282:939-944. doi:10.1016/j.jad.2021.01.002