Restricted accessResearch articleFirst published online 2018-11
Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section III: Evaluation of Atopic Dermatitis Patients for Comorbidities
Atopic dermatitis (AD) is often associated with other atopic diseases, including asthma, allergic rhinitis, atopy-associated eye disorders, and eosinophilic esophagitis. Depression and anxiety are also comorbidities to AD that significantly affect quality of life and should be screened for in patients with AD. Links to other comorbidities such as cardiovascular disease and malignancy are considered inconclusive, but patient counselling and screening may be appropriate in some patients. This article highlights practical recommendations for the recognition and management of atopic and nonatopic comorbidities commonly associated with AD.
ShawTECurrieGPKoudelkaCWSimpsonEL.Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2010;131(1):67-73.
3.
SilverbergJIHanifinJM.Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Invest Dermatol. 2013;132(5):1132-1138.
4.
AbuabaraKMargolisDJ.Do children really outgrow their eczema, or is there more than one eczema?J Invest Dermatol. 2013;132(5):1139-1140.
5.
BarbarotSAuziereSGadkariAet al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy. 2018;73(6):1284-1293.
6.
PesceGMarconACarossoAet al. Adult eczema in Italy: prevalence and associations with environmental factors. J Eur Acad Dermatol Venereol. 2015;29(6):1180-1187.
7.
AbuabaraKYuAMOkhovatJPAllenIELanganSM.The prevalence of atopic dermatitis beyond childhood: A systematic review and meta-analysis of longitudinal studies. Allergy. 2018;73(3):696-704.
8.
de Bruin WellerMSRockmannHKnulstABruijnzeel-KoomenC.Evaluation of the adult patient with atopic dermatitis. Clin Exp Allergy. 2012;43(3):279-291.
9.
SettipaneRACharnockDR.Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23-34.
10.
SavageJJohnsCB.Food allergy: epidemiology and natural history. Immunol Allergy Clin North Am. 2015;35(1):45-59.
11.
SearsMR.Trends in the prevalence of asthma. Chest. 2014;145(2):219-225.
12.
RomagnaniS.The increased prevalence of allergy and the hygiene hypothesis: missing immune deviation, reduced immune suppression, or both?Immunology. 2004;112(3):352-363.
13.
RogersAJCeledónJCLasky-SuJAWeissSTRabyBA.Filaggrin mutations confer susceptibility to atopic dermatitis but not to asthma. J Allergy Clin Immunol. 2007;120(6):1332-1337.
14.
KawasakiHNagaoKKuboAet al. Altered stratum corneum barrier and enhanced percutaneous immune responses in filaggrin-null mice. J Allergy Clin Immunol. 2012;129(6):1538-1546.e6.
15.
EliasPMSteinhoffM.“Outside-to-inside” (and now back to “outside”) pathogenic mechanisms in atopic dermatitis. J Invest Dermatol. 2008;128(5):1067-1070.
16.
LeungD.Our evolving understanding of the functional role of filaggrin in atopic dermatitis. J Allergy Clin Immunol. 2009;124(3):494-495.
HorimukaiKMoritaKNaritaMet al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824-830.e6.
19.
SimpsonELChalmersJRHanifinJMet al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818-823.
20.
CamargoCAGanmaaDSidburyRErdenedelgerKRadnaakhandNKhandsurenB.Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. J Allergy Clin Immunol. 2014;134(4):831-835.e1.
21.
NanzerAMChambersESRyannaKet al. Enhanced production of IL-17A in patients with severe asthma is inhibited by 1α,25-dihydroxyvitamin D3 in a glucocorticoid-independent fashion. J Allergy Clin Immunol. 2013;132(2):297-304.e3.
22.
EgebergAAndersenYGislasonGSkovLThyssenJ.Prevalence of comorbidity and associated risk factors in adults with atopic dermatitis. Allergy. 2017;72(5):783-791.
23.
KimSHHurJJangJYet al. Psychological distress in young adult males with atopic dermatitis: a cross-sectional study. Medicine (Baltimore). 2015;94(23):e949.
24.
ChengCMHsuJWHuangKLet al. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord. 2015;178:60-65.
25.
WamboldtMHewittJSchmitzSet al. Familial association between allergic disorders and depression in adult Finnish twins. Am J Med Genet. 2000;96(2):146-153.
26.
YarlagaddaAAlfsonEClaytonAH.The blood brain barrier and the role of cytokines in neuropsychiatry. Psychiatry (Edgmont). 2009;6(11):18-22.
27.
BieloryBBieloryL.Atopic dermatitis and keratoconjunctivitis. Immunol Allergy Clin North Am. 2010;30(3):323-336.
28.
ChenJJApplebaumDSSunGSPflugfelderSC.Atopic keratoconjunctivitis: a review. J Am Acad Dermatol. 2014;70(3):569-575.
29.
FujishimaHOkadaNDogruMet al. The role of staphylococcal enterotoxin in atopic keratoconjunctivitis and corneal ulceration. Allergy. 2012;67(6):799-803.
30.
ThyssenJPToftPBHalling-OvergaardASGislasonGHSkovLEgebergA.Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis. J Am Acad Dermatol. 2017;77(2):280-286.e1.
31.
HanifinJMRajkaG.Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980;92(suppl):44-47.
32.
BairBDoddJHeidelbergKKrachK.Cataracts in atopic dermatitis: a case presentation and review of the literature. JAMA Dermatol. 2011;147(5):585-588.
33.
WestlandTde Bruin-WellerMSVan der LelijA.Treatment of atopic keratoconjunctivitis in patients with atopic dermatitis: is ocular application of tacrolimus an option?J Eur Acad Dermatol Venereol. 2013;27(9):1187-1189.
34.
GooderhamMMcDonaldJPappK.Diagnosis and management of conjunctivitis for the dermatologist. J Cutan Med Surg. 2018;22(2):200-206.
35.
LegendreLBarnetcheTMazereeuw-HautierJMeyerNMurrellDPaulC.Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: a systematic review and meta-analysis. J Am Acad Dermatol. 2015;72(6):992-1002.
36.
ChengJZensSMDuellEPerryAEChapmanSMKaragasMR.History of allergy and atopic dermatitis in relation to squamous cell and basal cell carcinoma of the skin. Cancer Epidemiol Biomarkers Prev. 2015;24(4):749-754.
37.
RuffSEgebergAAndersenYGislasonGSkovLThyssenJ.Prevalence of cancer in adult patients with atopic dermatitis: a nationwide study. Acta Derm Venereol. 2017;97(9):1127-1129.
38.
HagstromerLYeWNyrénOEmtestamL.Incidence of cancer among patients with atopic dermatitis. Arch Dermatol. 2005;141(9):1123-1127.
39.
SilverbergJIGreenlandP.Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):721-728.e6.
40.
SuVYChenTJYehCMet al. Atopic dermatitis and risk of ischemic stroke: a nationwide population-based study. Ann Med. 2014;46(2):84-89.
41.
StandlMTeschFBaurechtHet al. Association of atopic dermatitis with cardiovascular risk factors and diseases. J Invest Dermatol. 2017;137(5):1074-1081.
42.
AndersenYEgebergAGislasonGHHansenPRSkovLThyssenJP.Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis. J Allergy Clin Immunol. 2016;138(1):310-312.e3.
43.
SilverwoodRJForbesHJAbuabaraKet al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ. 2018;361:k1786.
44.
SilverbergJI.Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies. Allergy. 2015;70(10):1300-1308.
45.
DruckerAMQureshiAADummerTJBParkerLLiWQ.Atopic dermatitis and risk of hypertension, type 2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project. Br J Dermatol. 2017;177(4):1043-1051.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
