“Affecting up to 25% of children and 7% to 11% of adults, AD is a chronic, pruritic, inflammatory dermatosis with significant impacts on QOL, overall health, and health system utilization,” explains Dawn Marie R. Davis, MD. “Research shows that AD in adults is associated with select allergic, atopic, immune-mediated, mental health, and bone health comorbidities, as well as skin infections. Clinicians need to be aware of these comorbidities associated with AD, in addition to some evidence supporting an association between AD in adults and substance use, attention deficit hyperactivity disorder (ADHD), and elements of metabolic syndrome.”

To examine research on the comorbidities associated with AD in adults, the American Academy of Dermatology (AAD) has released new AD guidelines, which are published in the Journal of the American Academy of Dermatology. This is the first in a four-part series that will also include sections on topicals, phototherapy/systemics, and pediatrics, according to Dr. Davis, co-chair of AAD Guideline Workshop. The work group conducted a systematic review of research regarding the association between AD and selected comorbidities and applied a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for prognosis approach for analyzing the certainty of the evidence, providing 32 statements of association based on the available evidence.

AD Linked With Many Other Disorders

“We created a guideline specifically dedicated to comorbidities because we recognize that AD is commonly linked to other disorders, including atopic conditions (asthma, allergic rhinoconjunctivitis, and food allergies), other skin disorders (alopecia areata, urticaria), and specific conditions (bone metabolism, metabolic conditions, and cardiovascular disease),” Dr. Davis points out. “We also wanted to emphasize the impact and association of mental health with AD (Table).”

The guidelines team, Dr. Davis says, seeks to convey that AD is a common inflammatory skin disorder that requires whole person care to be appropriately addressed. “We used a ‘bench to bedside,’ approach, relying on the latest research in AD to demonstrate these associations and their significance,” she says. “AD is a skin disease with significant impact on QOL, for both patients and their families. Skin disease can be uncomfortable, and management requires seeking medical care, which is time intensive and costly.”

Patients need education about the impact of AD to feel empowered and validated, Dr. Davis points out. “Conversations between the provider and patient are necessary for the patient to feel comfortable with the care plan and to understand what is involved,” she says. “It is important for clinicians to convey to patients that AD is a waxing and waning disease, with varying levels of severity, and is something to manage, rather than cure. Dermatologists are eager to serve as a resource for our colleagues to help with advanced treatment and management when necessary.”

Need More Studies Focused on Pediatric Patients

Dr. Davis and colleagues are hopeful that the new evidence highlighting the associations between AD and other organ systems will empower patients to seek optimal well-being and encourage healthcare providers to screen for such conditions. “We suggest that clinicians screen patients for the comorbidities identified when appropriate based upon the patient’s unique medical history and circumstance,” she says.

The study team acknowledges some gaps in research to assist patients with AD. “We need more studies focused on pediatric patients,” she says. “It would be helpful to have topical formulations of several immunomodulating drugs that are currently only available in systemic formulations. In addition, more research is needed on the treatment of concomitant conditions and how they impact AD. Finally, we need more information on possible preventative measures.”