Competition, Insurance Type Among Predictors of Irritating Symptoms in Atopic Dermatitis

Most of the patients with atopic dermatitis had fluctuating symptoms of depression, with or without public insurance, severe itching, and skin pain that were cited as additional mental health outcomes.

Many patients with atopic dermatitis (AD) have symptoms of depression, and several types have been shown to increase the risk of adverse health outcomes. The results of the study were published in the Journal of the American Academy of Dermatology (JADE).

As an inflammatory disease characterized by symptoms of chronic itching, skin pain, and insomnia, AD is associated with significant psychological distress and life burden. A forward JADE Studies have shown that about 1 in 3 US adults with AD report at least 1 symptom of depression and meet the criteria for a serious mental illness.

“A better understanding of the short-term symptoms of depression and their relationship with the severity of AD may help to distinguish patients whose symptoms of depression can improve in dermatology from those who should be referred to a psychiatrist,” said the study authors.

They conducted a dermatology-based study to examine the predictors and duration of depressive symptoms in adults aged 18 years and older enrolled from a single eczema clinic at an academic hospital between 2013 and 2020.

Participants completed a self-administered survey that measured age of AD onset, itchiness analog scale (VAS) and sleep to diagnose AD, skin pain score in the past 7 days, patient follow-up eczema, and patient-9 health questionnaires. (PHQ-9).

A complete examination of the skin of the body was also carried out by a dermatologist, who assessed the area of ​​eczema with the severity index (EASI), the severity of the lesions affecting different parts of the body (scalp, face, eyelids, inner neck, nipples, flexion, hands, and feet), and severity of associated symptoms (xerosis, ichthyosis, keratosis pilaris, and pityriasis alba).

695 elderly patients (mean [SD] age of enrollment, 44.2 [17.2] age; meaning [SD] AD years from, 19.93 [23.44] age; 63.69%) women were included in the study, of which 454 (65.32%) had mild, 139 (20.00%) were mild, 57 (8.20%) were moderate, 27 (3.88%) were severe, and 8 (2.59%) ) had severe depression.

Researchers noted that many patients have symptoms of depression, with symptoms of feeling bad, thoughts of self-harm, difficulty concentrating, and slow movement described as persistent.

Several predictors of worsening depression over time were shown in multivariable and multivariate models, the latter of which examined clinical characteristics and adjusted for demographics:

  • Age over 65 years (β, 0.330; 95% CI, 0.082-0.579)
  • Hispanic (β, 0.312; 95% CI, 0.171–0.454), African American (β, 1.739; 95% CI, 1.591–1.887), and other non-white race (β, -1.184; 95% CI, -1.277 to 1.091)
  • Male sex (β, 0.838; 95% CI, 0.659–1.017)
  • Patients with Medicaid (β, 3.880; 95% CI, 3.539-4.221), Medicare (β, 1.226; 95% CI, 0.901-1.550), and non-payer/self-pay (β, -1.005; -91% CI, 4.44) -15% to 1.091)
  • Facial erythema, both mild (adjusted β, 0.583; 95% Cl, 0.337 to -0.830) and moderate (adjusted β, 1.011; 95% Cl, 0.703-1.318)
  • Nipple eczema, all mild (adjusted β, 2.317 [1.773- 2.861]) and moderate (adjusted β, -3.863; 95% CI, -5.287 to -2.440)
  • Itch, both moderate (adjusted β, 0.938; 95% Cl, 0.603-1.273) and severe (adjusted β, 3.902; 95% Cl, 3.545-4.260)
  • Skin irritation, including mild (adjusted β, 1.092; 95% Cl, 0.718-1.466), moderate (adjusted β, 2.826; 95% Cl, 2.462-3.190) and severe (adjusted β, 4.107; 4.7 C; )

Sleep disturbances and the presence of pityriasis alba were also cited as predictors of worsening depression over time. The use of data from a single study center was identified by the researchers as a limitation of the findings.

“Physicians must recognize the significant mental health burden associated with AD and provide appropriate screening, treatment, and referral,” concluded the study authors. “Future AD treatments must include strategies to improve health and well-being in addition to treating disease.”

Book

Chatrath S, Lei D, Yousaf M, Chavda R, Gabriel S, Silverberg JI. Longitudinal course and predictors of depressive symptoms in atopic dermatitis. J Am Acad Dermatol. 2022 May 10;S0190-9622(22)00792-7. doi:10.1016/j.jaad.2022.04.061