Does eczema increase the risk of Deep Vein Thrombosis (DVT)?

Association Between Eczema and Deep Vein Thrombosis Risk

Eczema (atopic dermatitis) is associated with a small but significant increased risk of deep vein thrombosis (DVT), particularly in adults with severe disease, older individuals, and those with obesity.

Evidence for Increased DVT Risk in Eczema

Recent research provides compelling evidence for the association between eczema and venous thromboembolism:

• A large UK-based cohort study from 2023 found that adults with atopic dermatitis had a 17% higher risk of venous thromboembolism compared to matched controls, with a specific 30% increased risk of DVT 1.

• Another comprehensive cohort study using UK electronic health data demonstrated that adults with atopic dermatitis had a 14% higher risk of DVT compared to those without eczema, with the risk increasing to 64% in patients with severe eczema 2.

• A US-based study analyzing hospitalization data found that atopic dermatitis was associated with 22% higher odds of venous thromboembolism 3.

Risk Stratification

The risk of DVT in eczema patients varies based on several factors:

Age

• Older patients (≥65 years): Higher risk (22% increased risk) 1
• Middle-aged patients (45-65 years): Moderate risk (15% increased risk) 1
• Younger patients (<45 years): Minimal increased risk (7% increased risk, not statistically significant) 1

Disease Severity

• Severe eczema: Highest risk (64% increased risk of DVT) 2
• Moderate eczema: Intermediate risk
• Mild eczema: Lower but still present risk

Body Mass Index

• Obese patients (BMI ≥30): 25% increased risk 1
• Non-obese patients (BMI <30): 8% increased risk 1

Pathophysiological Mechanism

The association between eczema and DVT likely stems from:

1. Systemic inflammation: Chronic inflammation in atopic dermatitis may create a prothrombotic environment, similar to other inflammatory conditions 4.

2. Treatment effects: Some treatments for severe eczema, particularly JAK inhibitors, have been associated with increased VTE risk in certain populations, though this risk appears minimal in atopic dermatitis patients specifically 4.

Clinical Implications

Risk Assessment

• Consider DVT risk assessment in patients with eczema, particularly those with:
  • Severe disease
  • Older age (≥65 years)
  • Obesity
  • Additional risk factors for VTE

Monitoring

• Be vigilant for signs and symptoms of DVT in high-risk eczema patients:
  • Unilateral leg swelling
  • Pain or tenderness
  • Warmth or erythema

Prevention

• For high-risk patients (severe eczema with multiple risk factors):
  • Encourage physical activity
  • Avoid prolonged immobility
  • Consider prophylaxis during high-risk periods (e.g., hospitalization)
  • Educate about DVT symptoms

Important Caveats

1. While the risk increase is statistically significant, the absolute risk remains relatively low. A study using US claims data found crude incidence rates of VTE of 0.24 per 100 person-years for AD overall 5.

2. The increased risk appears to be primarily for DVT rather than pulmonary embolism, as one study found no increased risk of PE in eczema patients (adjusted HR 0.94) 1.

3. The risk association persists even after adjusting for corticosteroid use and other potential confounding factors 3.

4. Unlike other inflammatory conditions such as rheumatoid arthritis, which has a well-established VTE risk (4.7% vs. 2.5% in the general population), a cohort study of patients with AD failed to show a link between AD and VTE risk in some analyses 4.

In summary, while eczema does appear to confer a modest increased risk of DVT, particularly in severe cases and vulnerable populations, the absolute risk remains relatively low compared to other established risk factors for venous thromboembolism.