Patients with atopic dermatitis are likely to exhibit

We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.

The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting 18 million adults (7.2%) and 9.6 million children (13%) in the United States. Many psychiatric comorbidities are associated with AD.

Patients with AD are at significantly increased risk of suicidal ideation and suicide attempts than the general population, according to findings from a systematic review and meta-analysis.

April Armstrong, MD, MPH, was part of the team of researchers that conducted the study, published in JAMA Dermatology.[i] Armstrong is associate dean of clinical research and professor of dermatology at the Keck School of Medicine of USC.

Key Findings About AD and Suicide

Key study findings are:

• Compared to people without AD, patients with AD, are:
• 44 percent more likely to exhibit suicidal ideation (pooled odds ratio, 1.44; 95% CI, 1.25-1.65)
• 36 percent more likely to attempt suicide (pooled odds ratio, 1.36; 95% CI, 1.09-1.70).
• Results of studies about completed suicides in patients with AD were inconsistent.

Dermatologists should be aware of the risk of suicide among patients with AD, say the researchers. They should screen these patients for suicidality and make referrals to mental health providers when necessary.

Researchers reviewed 15 observational studies evaluating suicidal ideation, suicide attempts, and completed suicide among patients with AD. The studies covered:

• 310,681 AD patients:
• More than 4.4 million people without AD:

Study on Psoriasis and Suicide

In a separate systematic review and meta-analysis of psoriasis and suicidality, Armstrong and other researchers found that:

• Patients with psoriasis were twice as likely to consider suicide as the general population
• Psoriasis was significantly associated with both attempted and completed suicide.

 This study, published in the Journal of the American Academy of Dermatology,[ii] focused on 18 studies covering more than 1.76 million participants, including 330,207 patients with psoriasis.

Advancing Dermatologic Care

USC  Dermatology at Keck Medicine of USC manages rare and common skin diseases, such as psoriasis, atopic dermatitis, skin cancer, infectious diseases, autoimmune diseases and immunobullous diseases. Physicians see many patients with skin disorders or unusual presentations of common skin diseases.

Dr. Armstrong is one of the many of physicians who engage in groundbreaking dermatologic research. Keck Medicine of USC ranks in the top 10 in NIH funding for dermatology research, keeping USC Dermatology in the forefront of advancing care.

[i] Sandhu JK, Wy JJ, Bui RL, Armstrong AW. Association Between Atopic Dermatitis and Suicidality: A Systematic Review and Meta-analysis. JAMA Dermatology, 2018 Dec 12. doi: 10.1001/jamadermatol.2018.4566

[ii] Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: A systematic review and meta-analysis. Journal of the American Academy of Dermatology. September 2017, 77(3): 425–440.e2.

Overview

These facts and figures represent a summary of the most current information from published scientific literature regarding the prevalence of eczema and the burden people living with eczema face every day.

The Big Picture

31.6 million people (10.1%) in the U.S. have some form of eczema.

One in 10 individuals will develop eczema during their lifetime, with prevalence peaking in early childhood.

People of all skin colors, races and ethnicities can be affected by eczema:

• White – 11%
• African American/black – 10%
• Asian or Pacific Islander – 13%
• Native American – 13%

Prevalence of Childhood & Adult Atopic Dermatitis (AD)

Approximately 9.6 million U.S. children under the age of 18 have AD, and one-third have moderate to severe disease.

The prevalence of childhood AD has steadily increased from 8% to ~12% since 1997.

An estimated 16.5 million U.S. adults (7.3%) have AD that initially began at >2 years of age, with nearly 40% affected by moderate or severe disease.

Atopic dermatitis is not solely a disease of childhood onset; 1 in 4 adults report adult-onset of initial symptoms.

Atopic dermatitis affects a similar number of male and female children, however, studies have shown it is more common in adult females than males.

In the U.S., AD affects more African-American/black children and European-American children compared to Hispanic children.

Although study percentages vary, adults that are multiracial or white tend to have the highest prevalence of atopic dermatitis.

African-American/black and Hispanic children tend to have more severe AD compared to white children.

Children born outside the U.S. have a 50% lower risk of developing AD that increases after living in the U.S. for 10 years.

80% of individuals affected with AD experience disease onset prior to 6 years of age, and current data suggests at least 80% will “outgrow” their AD by adolescence or adulthood.

Children with more severe, persistent AD have a higher risk for prolonged disease, although AD may persist regardless of severity.

Impacts of Eczema

Disease Burden & Mortality

Itch is the most burdensome symptom of AD, followed by skin redness and dryness.

A recent study of adults with moderate to severe AD found that 70.5% reported severe, unbearable itch in the past two weeks, 85.8% reported daily itch, and 62.8% reported itching at least 12 hours per day.

Skin pain is a newly appreciated symptom of AD, with 61% of affected adults reporting pain, 33% experienced pain at least once per week, and 5.2% had pain daily.

Sleep disturbance occurs in approximately 60% of children with AD, and parents of children with AD are four to eight times more likely to average less than six hours of sleep per night compared with caregivers of healthy children.

15-30% of adults with AD experience sleep-related issues including insomnia, daytime sleepiness and fatigue, and rate sleep disturbance as the ‘most’ or ‘second-most’ burdensome symptom.

More than 55% of adults with moderate-to-severe AD report inadequate disease control.

One in four adults with AD rate their health as “fair” or “poor”; more than 16% are “very” or “somewhat” dissatisfied with life. Negative ratings of health and life satisfaction increase with AD severity.

Hospitalization due to AD flares and associated infections is associated with an 8.3-year reduction in lifespan compared to the general population. Outside of hospitalization, the risk for death due to any cause is slightly increased in people with AD.

Eczema has the highest effect on disability-associated life years for patients with skin diseases worldwide.

Comorbid Conditions

Atopic Conditions

Children with AD often develop other atopic conditions in a typical sequence of food allergy, allergic rhinitis and asthma – known as the atopic march. Some of these conditions may persist for years, others may resolve with increasing age.

One in three children with AD will additionally develop asthma or allergic rhinitis. The risk of developing asthma increases with AD severity as more than 50% of children with severe AD will develop asthma.

Young children with AD are 6 times more likely to develop a food allergy compared to children without AD.

More than 20% of adults with AD also have asthma, and they have a two to four times increased risk for having allergic rhinitis and food allergy.

People with atopic dermatitis are at increased risk of developing serious bacterial, viral and fungal skin infections.

Autoimmune and Cardiac Disease

AD in adults is associated with other serious chronic conditions that contribute to poor health including diabetes, obesity, autoimmune disease, high blood pressure and heart disease. Risk for these conditions increases with AD severity.

Infections

For hospitalized adults with AD, the prevalence of serious infections including cutaneous, respiratory and systemic (heart, brain, GI, bone) infections is significantly higher compared to those without AD.

Ocular Conditions

Adults with AD have an increased risk of eye-related conditions including conjunctivitis, keratitis, and keratoconus; this risk increases with AD disease severity.

Neuropsychiatric Conditions

Children with AD are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD).

Children and adolescents with AD are two to six times more likely to have depression, anxiety or conduct disorder than children without AD.

Adults with AD have a two-and-a-half to three-fold higher risk for anxiety or depression that increases with disease severity, yet up to one-half of individuals may go undiagnosed.

AD’s negative impact on mental health ranks greater than that for patients with heart disease, diabetes and high blood pressure.

Recent studies have suggested people with AD are up to 44% more likely to exhibit suicidal ideation, and 36% are more likely to attempt suicide.

Childhood AD has a significant impact on the emotional and social well-being of parents and caregivers.

Lifestyle Impacts

Half of adults with moderate to severe AD indicate that AD significantly limits their lifestyle; nearly 35% of adults with mild AD also experience some lifestyle limitations.

More than one-third of people with AD say they “often” or “always” feel angry or embarrassed by their appearance due to the disease.

One-third to one-half of adults with AD avoid social interactions because of their appearance.

Parents and caregivers of children with AD report feeling embarrassed about their child’s appearance as well as frustration, helplessness, sadness and guilt due to their child’s disease.

Children, adolescents and young adults with eczema often feel isolated from their peers due to disease-related lifestyle restrictions.

Pre-adolescent girls with AD more frequently report impaired self-perceived health than their male counterparts.

One in four children and teens with AD have experienced bullying because of their disease.

Nearly one-third of adults with AD have experienced challenges in school or their work life, and 14% of adults believed that their academic and/or career progression has been hindered by AD.

Nearly 40% of patients with eczema reported that they turned down a job or an educational opportunity due to their disease.

More than 85% of people with AD indicate their disease affects the type of clothes worn by “somewhat” or “a lot.” Girls report more problems with clothing choices than boys.

One in three adults with AD and their partners have reported that eczema interfered with establishing relationships and their sexual health.

Economic & Societal Impact

Adults with AD, regardless of disease severity, are more likely to take five or more days off work annually compared to their non-affected coworkers.

Nearly 5.9 million workdays annually are lost due to eczema.

People with AD have higher overall work impairment compared to non-affected coworkers. Approximately 15% of the workday can be impacted by disease flares.

Parents of children with AD experience lost work productivity that relates to their child’s AD severity.

U.S. adults with moderate to severe AD have nearly 16% less employment than those with mild AD.

People with AD have increased health care utilization than those without AD including:

• $371-$489 higher out-of-pocket costs per person each year, which is higher than the out-of-pocket costs for hypertension and diabetes.
• More outpatient doctor visits
• More visits to urgent/emergency care
• More hospitalizations

Cost of care considerations have been reported for AD patients:

• 17.6% delayed care due to concerns about cost
• 13.1% did not seek care due to concerns about cost
• 15.7% report an inability to cover the cost of prescriptions

Inpatient costs for AD care reach nearly $8.3 million/year for adults and more $3.3 million/year for children.

Total direct medical costs in 2013 averaged $11,660 per AD patient, which represents an incremental cost of $3,302 annually. Costs are higher in patients with more severe disease.

In 2013, the cost to the health system to treat atopic dermatitis patients was $314 million.

The annual economic burden of eczema, including direct medical costs, indirect costs from lost productivity, and quality of life impacts, is conservatively estimated at $5.3 billion.

References