Atopic dermatitis (AD) can be complicated by infections, allergic and nonallergic comorbidities and quality of life impairments. Understanding the severity of the disease and its comorbidities and how it affects vulnerable populations is important for clinicians who encounter AD.
AD is an inflammatory, relapsing skin disease that follows a chronic, relapsing course and is characterized by intense pruritus, maculopapular or vesicular erythematous lesions and scaling, and lichenification. Patients with AD are much more likely to have other allergic-related diseases. Children with AD often undergo ‘atopic march’, which refers to the progression of allergic diseases that occurs early in life, including AD, food allergy, allergic rhinitis and asthma. One in three children with AD also develops asthma or allergic rhinitis, and the risk of asthma increases with AD severity. Among children with severe AD, more than half will go on to develop asthma. [Spergel 2010] These diseases also go hand-in-hand among adults with AD, as over 20% of adults with AD also have asthma. [Silverberg 2013] The epithelial barrier disturbance that is the hallmark of AD also increases the likelihood of developing serious bacterial, viral and fungal skin infections, with 60%-90% of those with AD having a Staphylococcus aureus infection during their disease course.
AD has also been associated with non-allergic comorbidities. Patients with AD have found to have a higher prevalence of obesity, diabetes, heart disease, autoimmune disease, anxiety, depression, and other chronic conditions. [Silverberg 2019]. These comorbidities were found to be correlated with the severity of AD, which suggests that AD severity is a major contributing factor in the development of multiple diseases. This is particularly important when treating AD among African Americans, as this population have been found to be more likely to have severe AD than non-African Americans. [Poladian 2019; Silverberg 2019] In a recent study, adults with AD were also found to have higher rates of hypertension, high cholesterol, prediabetes, adult-onset diabetes, coronary artery disease, angina, heart attack, congestive heart failure, stroke, and/or peripheral vascular disease. [Cheng 2019] Children diagnosed with AD have also been found to have higher levels of sleep disturbances, attention deficit hyperactivity disorder, depression and anxiety. [McKenzie 2019]
AD is a chronic disease and has been associated with decreases in the quality of life among patients. Among children with AD, there is an increased prevalence of school absenteeism, bullying and challenges in completing schoolwork, as well as negative impact on social support and interactions and increased feelings of isolation. Patients with AD also bear a higher healthcare burden, with higher than normal levels of out-of-pocket costs, outpatient visits, and hospitalizations. [Hua 2019] This can be especially true of in African American patients, who were found to have higher rate of office visits for AD than white patients. [Sanyal 2019] The chronic nature of AD has been found to put financial strain on patients, due to the high number of office visits and treatment medications needed over the course of the disease. [Koszuru 2019] AD has been found to affect patient’s quality of life, with negative impacts on mental health, sleep, physical activity, social functioning, as well as academic and occupational performance. The negative impacts on QOL have also been found to be greater in patients of color. [Poladian 2019]
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