People affected by atopic dermatitis often also have allergies or asthma. This simultaneous occurrence of one or more other diseases alongside an existing underlying disease such as atopic dermatitis is known as comorbidity (concomitant disease). It has now been discovered that the comorbidities of atopic dermatitis require us to look beyond allergic diseases.
Understanding the overall system of atopic dermatitis
Various concomitant diseases of atopic dermatitis are becoming the focus of research. New concomitant diseases have been discovered that are associated with atopic dermatitis. However, these are not allergic diseases. This focus in research is aimed at high-quality and early treatment of the diseases. But not only that; atopic dermatitis is now increasingly being recognised as a systemic disease. This means that atopic dermatitis is not just reduced to the skin and the corresponding inflammatory processes, but is better understood, seen and treated as a whole.
Concomitant diseases that occur more frequently with atopic dermatitis:
Infections
These include certain skin infections as well as infections of the respiratory tract, urinary tract and gastrointestinal tract. The increased susceptibility to infections can be caused by the weakened skin barrier in atopic dermatitis. However, the interaction of low vitamin D levels, tobacco smoke and air pollution, for example, can also favour these infections.
Psychological disturbances
Atopic dermatitis is associated with depression, anxiety disorders, emotional problems and attention-deficit/hyperactivity disorder (ADHD), among other things. This connection is influenced by:
- Severity and duration of atopic dermatitis
- Sleep disorders and reduced quality of life due to atopic dermatitis
- Mutual influence of atopic dermatitis and mental health.
Obesity
Obesity appears to be associated with atopic dermatitis in both childhood and adulthood, although the exact links are still unclear. Not only the genes, but also gut microbiomes might have an important influence here.
Cardiovascular diseases
There is increasing evidence that adults with atopic dermatitis have a higher risk of congestive heart failure and coronary heart disease. Adult cardiovascular disease and atopic dermatitis share common risk factors, including mental health problems and obesity.
Autoimmune diseases
Chronic inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis), celiac disease and circular hair loss are examples of autoimmune diseases that are generally more common in allergic diseases and atopic dermatitis in particular. It is more likely to be genetic influences rather than the patient’s age, gender or duration of atopic dermatitis that play a role here.
How can we interpret this information?
These observations should be taken seriously, but you must also take into account the following considerations:
- the mechanisms behind the correlations are often still unclear
- many factors influence the development of the concomitant diseases, which is difficult to keep track of.
- it is not always known exactly how high the risk is in each individual case
What should you remember?
Understand the risks and talk to your physician about them, especially if you have diagnoses or symptoms in any of these areas.
But don’t go crazy: not every symptom is a new illness. Nevertheless, you can ask yourself: “What is good for me as a whole? What does my body need?”
References:
- Paller, A., Jaworski, J.C., Simpson, E.L. et al. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol 19, 821–838 (2018). https://doi.org/10.1007/s40257-018-0383-4 (external)
- Brunner, P. M., Silverberg, J. I., Guttman-Yassky, E., Paller, A. S., Kabashima, K., Amagai, M., Luger, T. A., Deleuran, M., Werfel, T., Eyerich, K., Stingl, G., & Councilors of the International Eczema Council (2017). Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder. The Journal of investigative dermatology, 137(1), 18–25. https://doi.org/10.1016/j.jid.2016.08.022 (external)
