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Comorbidity is common in adult and paediatric atopic dermatitis patients

Presented by
Prof. Jonathan Silverberg, George Washington University, WA, USA
AAD VMX 2021
Most atopic dermatitis patients have a higher comorbidity compared with the general public; this is even true for paediatric patients.

Comorbidity of atopic dermatitis (AD) has been studied extensively. There is a plethora of concomitant diseases not only from the allergic disease spectrum (e.g. food allergy, hay fever, or asthma) but also other diseases including sleep disturbances, psychiatric comorbidities such as anxiety and depression, and an elevated cardiovascular risk. Having a comorbid health disorder does not always equate to patients having poor health outcomes. “Therefore, it is important to determine who the ‘sick’ patients are,” explained Prof. Jonathan Silverberg (George Washington University, Washington DC, USA) [1].

Generally, multimorbidity is most common in the elderly, but some diseases such as rheumatoid arthritis, systemic sclerosis, or cancer can also increase the risk of multimorbidity in younger populations. A common tool to assess comorbidity is the Charlson Comorbidity Index (CCI). In a Danish case-control study including 10,738 adults with an AD diagnosis and 42,952 controls, patients had significantly higher CCI scores than controls (0.13 vs 0.09; P<0.001) [2]. Specific patient subsets with increased CCI included severe AD patients and smokers with AD. Another study demonstrated that multimorbidity according to CCI scores and estimated 10-year survival were similar between AD and psoriasis [3]. “We also assessed the multimorbidity in children with AD and found that young children aged <11 years with mild-to-moderate AD or severe AD and adolescents with mild-to-moderate AD had significantly higher CCI scores compared with no-AD populations,” Prof. Silverberg stated [4]. AD patients with atopic comorbidities had a particularly increased multimorbidity score.

But why are some AD patients “sicker” with multimorbidity, yet most do not have multimorbidity? According to Prof. Silverberg, there are probably a couple of reasons, including genetics (filaggrin mutations are a possible culprit), immunology, and environmental causes such as smoking. “AD patients with multimorbidity would likely benefit from interdisciplinary coordination of care,” he said. CCI is only a research tool and in daily practice comorbidity should be assessed by a thorough medical history and assessment of health-related quality of life using more global scales such as the PROMIS global health. “These tools more holistically assess the impact of AD and comorbidities,” Prof. Silverberg concluded.

  1. Silverberg J. Multimorbidity of atopic dermatitis. Session S006: Atopic dermatitis. AAD VMX 2021, 23-25 April.
  2. Thyssen JP, et al. J Am Acad Dermatol 2017;76(6):1088-92.
  3. Narla S, Silverberg J. Arch Dermatol Res 2020;312:507-12.
  4. Cheng BT, et al. Dermatitis 2020; Sep8 [online ahead of print].

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