Individuals with atopic dermatitis may be at risk for developing other comorbid conditions. Having a comorbidity or comorbid condition means that an individual possesses two or more chronic conditions at the same time. For example, if an individual has atopic dermatitis and asthma, these would be considered comorbid conditions since they are chronic conditions occurring together. Sometimes, having a condition may increase your risk of developing a second, or more, conditions. The causes for this may be due to genetics, environmental exposures, lifestyle choices, and more.1 The exact mechanism by which atopic dermatitis co-occurs with other conditions is not completely understood, and more research is currently being done to investigate these links. Some examples of potential comorbid conditions that can occur with atopic dermatitis are outlined below.
Other atopic conditions
The link between other atopic conditions and atopic dermatitis is perhaps the most thoroughly researched and understood. It is hypothesized that the main issue linking these conditions together is faulty production of an antibody called immunoglobulin E (IgE).2 Normally, these antibodies are released when the body needs to fight off a foreign invader or infection, however, for individuals with atopic conditions, IgE is often overproduced or produced when it’s not needed, leading to an allergic reaction and accompanying symptoms. Conditions in this group that can co-occur with atopic dermatitis include allergic rhinitis (allergies with symptoms affecting the nose or throat), food allergies, and asthma. Common theories as to why these conditions often occur together include genetic predispositions and environmental exposures.1,3,4
More research needs to be done to investigate the link between atopic dermatitis and cardiovascular complications, however, some evidence has pointed toward individuals with atopic dermatitis having an increased risk of developing conditions including hypertension (high blood pressure), coronary artery disease, heart attack, congestive heart failure, angina (severe chest pain), peripheral vascular disease, and ischemic stroke. The reasons for this are not well understood, however, some theories suggest that this potential connection may be related to genetics, side-effects of atopic dermatitis medications, and/or lifestyle choices. For example, studies have indicated that individuals with atopic dermatitis in the United States are, on average, less likely to have vigorous daily activity than those without the condition. This lack of exercise could be due to quality of life-impacting symptoms of atopic dermatitis, including pruritus and psychological stress. A lack of exercise, in turn, can lead to obesity, which can cause high blood pressure, type 2 diabetes, and other cardiovascular events. In addition, participating in other unhealthy lifestyle behaviors such as smoking, high consumption of alcohol, or poor diet, can also lead to further complications.1,3
Some experts classify atopic dermatitis as an autoimmune condition, and research suggests that autoimmune conditions tend to come in clusters. This means, that having one autoimmune condition may increase your risk of developing another, or more, autoimmune conditions. This may be due to genetics, environmental exposures, and other lifestyle choices. Common autoimmune conditions thought to be associated with atopic dermatitis include, but are not limited to, inflammatory bowel disease, alopecia areata, lupus erythematosus, vitiligo, chronic urticaria (hives), celiac disease, autoimmune nephropathy (kidney disease), and autoimmune thyroid disease.1,3
Another less understood area of potential comorbidity is cancer in individuals with atopic dermatitis. Evidence has pointed towards an increase in risk of developing basal cell carcinoma in individuals with atopic dermatitis. This may be due to immune system suppressing medications, phototherapy, genetics, environmental exposures, lifestyle choices, obesity, chronic inflammation, or a weakened skin barrier that doesn’t shield UV rays as well. Other skin cancers, such as malignant melanoma or squamous cell carcinoma have not been found to be associated with atopic dermatitis at this time. It has also been hypothesized that atopic dermatitis may be associated with lymphoma due to many of the previously mentioned risk factors, especially immune system-modulating medications and chronic inflammation.1
There is also some preliminary evidence that suggests that atopic dermatitis may lead to an increased risk of developing HPV infections of the cervix in women, which could lead to cervical cancer. However, more research is needed to further understand this potential link.1
The potential connection between atopic dermatitis and neurological conditions is actively being researched. It has been theorized that atopic dermatitis can increase the risk of developing psychological stress, anxiety, or depression, especially in cases where atopic dermatitis symptoms are severe. This increase in mental health-related conditions could be due to sleep disturbances, social stigma, financial concerns that come along with treatment, or the overall impact of atopic dermatitis on quality of life. Additionally, some evidence has pointed toward a potential connection between atopic dermatitis and attention deficit hyperactivity disorder (ADHD) and conditions on the autism spectrum (autism spectrum disorders). These potential connections need much more investigation and are hypothesized to be related to chronic inflammation and genetics.1,3
This is not an exhaustive list of all potential comorbid conditions that can co-occur with atopic dermatitis. Additionally, many of these potential links need much more investigation to better understand the complex connections that may be at work. If you are concerned that you may have a comorbid condition with your atopic dermatitis or want to learn more about your specific risk of developing another condition, contact your doctor or healthcare team.
Andersen YMF, Egeberg A, Skov L, Thyssen JP. Comorbidities of atopic dermatitis: Beyond rhinitis and asthma. Curr Derm Rep. 21 Jan 2017; 6, 35-41. Available from https://link.springer.com/content/pdf/10.1007%2Fs13671-017-0168-7.pdf. Accessed February 25, 2018.
Immunoglobulin E (IGE). American Academy of Allergy Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/immunoglobulin-e-(ige). Accessed February 25, 2018.
Silverberg NB, Jacob S. Atopic Dermatitis, Psoriasis Have Similar Comorbidities. American Academy of Pediatrics. http://www.aappublications.org/news/2017/03/29/Dermatology032917. Published March 29, 2017. Accessed February 25, 2018.
Moreno MA. Atopic Diseases in Children. JAMA Pediatr. Jan 2016; 170(1), 96. Available from https://jamanetwork.com/journals/jamapediatrics/fullarticle/2478040. Accessed February 25, 2018.