Atopic Dermatitis May Be More Than Skin Deep
April 12, 2023
Atopic Dermatitis (AD) is a common, chronic, inflammatory skin condition characterized by persistent itchiness, dryness and lesions or cracking or flaking skin. It is commonly called Eczema and can include skin eruptions, redness, bumps, and lesions that may spread, depending on the patient’s age and varying extents of skin dryness. It is estimated that one in ten Americans suffer with Atopic Dermatitis.
Recently a group of dermatology researchers set out to provide a summary of plausible explanations for why AD may be related, with greater prevalence, to certain cardiovascular diseases, neuropsychiatric diseases (such as epilepsy, autism, attention deficit hyperreactivity disorder, and depression), autoimmune diseases (alopecia areata, vitiligo, rheumatoid diseases, type I diabetes (T1D)), and obesity.
To prove their hypothesis, the authors looked for supporting literature using the PubMed database with search queries “atopic dermatitis and comorbidities”, “atopic dermatitis and cardiovascular comorbidities,” “atopic dermatitis and neurological comorbidities,” “atopic dermatitis and psychiatric comorbidities” and “atopic dermatitis and autoimmune comorbidities.”
Based on the analysis of titles and abstracts, the researchers included articles on the causes of the increased co-occurrence of atopic dermatitis, including genetic factors, immunological factors, and exposure to modifiable risk factors.
Medical research has previously established that regular physical activity aids in the primary and secondary prevention of a number of chronic diseases including obesity, depression, and cardiovascular diseases. Researchers in this study found research that linked adult AD with decreased physical activity in the USA. Patients with eczematous skin lesions on their palms and soles might find it difficult to participate in a variety of activities, but also elevated skin temperature and perspiration are known flare triggers for AD outbreaks. Additionally, sleep disturbance and depression, which often occur in AD patients, can make it more difficult to maintain a regular exercise routine.
AD was also found to be associated with an increased incidence of eating disorders, with bulimia nervosa and binge eating disorder being the most prevalent, with the researchers explaining that incorrect administration of a systemic treatment for AD can be a factor in these issues.
Regarding cardiovascular disease, the authors found contrasting opinions in studies that looked at a possible link with AD. In one study, a 1-year history of AD in the United States was associated with a higher prevalence of coronary artery disease, angina pectoris, myocardial infarction, stroke, and peripheral vascular disease. But in a German study, AD patients experienced an elevated risk of angina pectoris, hypertension, and PVD, but not of MI or stroke. The authors explained this by noting that a variation in endotypes and lifestyle choices between the countries could account for the observed differences.
While the higher cardiovascular risk in psoriatic patients as, at least to some extent, a result of elevated levels of immune and cardiovascular proteins is a well-established concern, the data on AD are less researched and still emerging.
Some of the other research findings theorized that AD increases blood platelet activation and oxidative stress while decreasing fibrinolysis—both of which could be contributing factors to the development of thrombosis. Yet different studies indicated that the function of platelet aggregation was not impaired in AD patients, claiming that a higher activity of proinflammatory mast cells and tryptases decreased the risk of thrombosis by tryptase-mediated degradation of fibrinogen, a thrombosis mediator, and creation of a complex between heparin and tryptase, resulting in anticoagulation.
Based on their overall findings, the researchers concluded that AD is indeed associated with multiple comorbid allergic, cardiovascular, mental health, neurologic, autoimmune, and metabolic conditions.
Still, they warn that it’s vital to determine the extent to which this coexistence is linked to exposure to, often modifiable, risk factors, as well as genetics and immune dysregulations.
Another key point they shared is analyzing the immunology of chronic inflammation whose correction, activation, or suppression would theoretically aid in preventing the development of a variety of comorbidities.
More research is needed to determine how non-dermatology conditions contribute to dermatological diseases. Clinicians and patients should be made aware of non-allergic comorbidities associated with AD and attempt to detect them and treat them as a potential contributors to AD conditions. Treatment of non-dermatological condition may affect changes in conditions like AD.
Do you have AD? Do you have other conditions described in this article that might be contributing to your dry, itchy skin? Dr. Moore and her team offer a variety of treatments for AD. Dr. Moore also participates in a number of Atopic Dermatitis clinical trials that will offer free medicine and free treatment for AD. Text or call us at 817-755-5542 to see if you qualify for an AD clinical trial. Learn more at www.arlingtonskindoctor.com.
Source: Dermatology Times March 2023