While atopic dermatitis frequently resolves during childhood, it can continue into adulthood. In fact, a recent study suggested that approximately half of childhood cases extended into adult life (Napolitano et al., 2016).
The burden of atopic dermatitis also continues into adulthood. A study of 349 adult patients with atopic dermatitis identified in the 2013 U.S. National Health and Wellness survey were compared with propensity score-matched patients without atopic dermatitis and patients with psoriasis. Compared to patients without atopic dermatitis, patients with atopic dermatitis had a significantly increased risk for arthritis (OR 1.7; 95% CI 1.3 – 2.3; p<0.001), asthma (OR 3.3; 95% CI 2.3–4.7; p<0.001) and nasal allergies/allergic rhinitis (OR 2.9; 95% CI 2.2–3.8; p<0.001). Surprisingly, the comorbidity risk was not significantly different between patients with mild atopic dermatitis and moderate-severe atopic dermatitis, although it was numerically higher in patients with moderate-severe disease (Eckert et al., 2018). When compared to patients with psoriasis, patients with atopic dermatitis had significantly higher odds of having comorbid asthma (OR 1.7; 95% CI 1.1–2.7; p=0.01), and nasal allergies/allergic rhinitis (OR 2.3; 95% CI 1.6–3.2; p<0.001) while patients with psoriasis had an increased risk of hypertension (OR 0.7; 95% CI 0.5–1.0; p=0.03) (Eckert et al., 2018). As in childhood atopic dermatitis, adults with atopic dermatitis also have significantly higher odds of ADD/ADHD (OR 1.61; 95% CI 1.25–2.06) after adjusting for sociodemographics, allergic disease and healthcare utilisation (Strom et al., 2016).
Another article by Eckert et al. investigated the health-related quality of life (HRQoL) in the same patient population (Eckert et al., 2017).
While significantly more patients with atopic dermatitis reported a mood or sleep disorder than patients without atopic dermatitis (Figure 9), no significant differences were seen when compared to patients with psoriasis. When comparing HRQoL, patients with atopic dermatitis had significantly worse mental and physical domains than patients without the condition, and comparable HRQoL to patients with psoriasis (Eckert et al., 2017). Similar results were seen in a cross-sectional survey of dermatological out-patients in 13 European countries. In this study, patients with dermatological conditions were significantly more likely to have depression than controls with atopic dermatitis (OR 3.27; 95% CI 1.61–6.62) and psoriasis (OR 3.02, 95% CI 1.86–4.90) having the third and fourth highest odds ratios, respectively behind leg ulcers and hand eczema (Dalgard et al., 2015). Suicidal ideation was also seen to be significantly increased in adult patients with atopic dermatitis compared to healthy controls. In a cross-sectional survey of 181 patients and 64 controls, depressive symptoms, anxiety symptoms and suicidality were all significantly increased in patients with atopic dermatitis. In fact, 3.9% of patients, but no control subjects, presented with suicidality scores that might indicate an acute suicidal crisis (Dieris-Hirche et al., 2017).
The health implications of living with atopic dermatitis can also impact patients’ work productivity. In the 2010 U.S. National Health Interview Survey, 12.2% of participants with atopic dermatitis missed 1–2 days of work due to their condition while 2.3% reported missing 3 or more days (Silverberg, 2015). Compared to people without atopic dermatitis, employed patients with atopic dermatitis reported higher absenteeism (9.9% vs. 3.6%; p<0.001), presenteeism (21.1% vs. 16.1%; p=0.027) and overall work impairment (25.6% vs. 18.1%; p=0.004). The impact of atopic dermatitis and psoriasis on productivity were comparable (Eckert et al., 2017). The burden was also comparable between patients with mild disease and moderate-severe disease. While the burden for absenteeism, presenteeism and overall work impairment was numerically higher in patients with more severe disease, it was not statistically significant (Eckert et al., 2017).
Interestingly, atopic dermatitis doesn’t appear to just affect people’s productivity at work but also their progression at work and even the work they do. While 14% of adults in the International Study on Life with Atopic Eczema believed that their career progression had been held back by their condition (Zuberbier et al., 2006), patients with atopic dermatitis have also reported avoiding careers where their skin may be an issue such as healthcare, food preparation, cleaning, hairdressing, and automobile repair (Nyren et al., 2005; Holm et al., 2006).