People with atopic dermatitis (AD) may be at increased risk for depression and anxiety, and this risk increases with more severe and poorly controlled disease, according to a new review article in the Annals of Allergy, Asthma and Immunology.

Adults with AD have a 2- to 3-fold greater risk for depression and anxiety compared with individuals without AD, and children are at a 1.5-fold greater risk, with greatest risk for those with more severe disease, the study showed.

“The psychosocial burden of atopic dermatitis (AD) is extensive, stemming from intense itch, sleep disturbance, unpredictable flares, social stigma, treatment burden, lifestyle restrictions, and missed activities,” the researchers report. “Although depression and anxiety are known comorbidities of AD, the mental health burden of AD often goes unaddressed, which may further a sense of isolation for patients and families.”

There are no consensus guidelines for specific screening procedures, but the use of validated measures that have been well-established in primary care and/or validated within AD populations is a reasonable starting point, the researchers suggest.

Existing research supports use of cognitive-behavioral interventions to help manage the physical and mental health burden of AD, they note.

What to Do Now

Health care professionals can support patients with AD and their caregivers by encouraging open conversations about mental health, addressing common areas of condition-related stress, screening for depression and anxiety, and facilitating referrals to mental health professionals for further assessment and evidence-based care.

“Further research is needed to evaluate psychological interventions for pediatric patients with AD and for patients with clinical diagnoses of depression and anxiety to better guide shared decision-making around support for these patients.”