What systemic illnesses cause atopic dermatitis (eczema)?

From the Guidelines

Atopic dermatitis (eczema) is strongly associated with systemic illnesses such as asthma, allergies, mental health conditions like depression and anxiety, and other immune-mediated conditions, as evidenced by the American Academy of Dermatology guidelines 1. These associations are crucial for clinicians to recognize, as they can impact the diagnosis and treatment of atopic dermatitis.

Key Associations

• Atopic comorbidities, such as asthma, can help establish the diagnosis of atopic dermatitis and may influence treatment selection, particularly with the use of biologics and other targeted agents 1.
• Mental health conditions, including depression and anxiety, are commonly associated with atopic dermatitis, and successfully treating atopic dermatitis may alleviate depressive symptoms in some patients 1.
• There is also limited but consistent evidence supporting a link between atopic dermatitis and adverse bone health, including osteoporosis and fractures, possibly due to the use of systemic corticosteroids 1.
• Associations between atopic dermatitis and cardiovascular risk factors and comorbidities are more controversial, with some studies suggesting an increased risk but the absolute risk attributable to atopic dermatitis being small 1.

Management Considerations

• Treatment should focus on addressing the underlying systemic condition while providing symptomatic relief for atopic dermatitis with appropriate moisturizers, topical anti-inflammatory medications, and avoiding triggers that exacerbate symptoms.
• Identifying and treating the underlying systemic illness is crucial for effective management of the associated eczematous skin condition.
• Clinicians should be aware of the potential associations between atopic dermatitis and other systemic illnesses to provide comprehensive care for patients with atopic dermatitis.

From the Research

Systemic Illnesses Associated with Atopic Dermatitis

• Atopic dermatitis has been linked to various systemic autoimmune diseases, including:
  • Alopecia areata 2
  • Celiac disease 2
  • Crohn's disease 2
  • Rheumatoid arthritis 3, 2
  • Systemic lupus erythematosus 3, 2
  • Ulcerative colitis 2
  • Vitiligo 2
• The association between atopic dermatitis and these autoimmune diseases may be due to shared underlying pathological mechanisms, such as immune dysregulation and cutaneous barrier dysfunction 4
• Atopic dermatitis has also been associated with an increased risk of cardiovascular disease, cutaneous and extracutaneous infections, and neuropsychiatric conditions, including mental health disorders 4

Pathogenesis and Comorbidities

• Atopic dermatitis is characterized by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors, which disrupts the epidermis and causes intensely pruritic skin lesions 5
• The concept of atopic dermatitis as a biphasic Th1-Th2 disease is changing, with recent evidence supporting systemic activation of other multiple Th-cell subsets 4
• The atopic march, which represents the natural progression of atopic diseases, often starts with the development of atopic dermatitis, followed by other atopic conditions, such as asthma and allergic rhinitis 4