Depression and anxiety in patients with atopic dermatitis

The psychosocial burden of atopic dermatitis (AD) is extensive, stemming from intense itch, sleep disturbance, unpredictable flares, lifestyle restrictions and missed activities, social stigma, and treatment burden. Overall, adults with AD are at a 2- to 3-fold greater risk for depression and anxiety compared with individuals without AD and children at a 1.5-fold greater risk, with greatest risk for those with more severe disease. A number of mechanisms seem to affect the relationship between AD and mental health, including poorly controlled disease, sleep disturbance, stress-induced itch, inflammation, and coping patterns. In some cases, the mental health burden of AD may also negatively affect AD management and course, creating a reinforcing cycle of psychosocial burden. 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. Given the strong association between symptom severity and increased mental health burden, optimizing AD treatment and reducing itch are critical. 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. Existing research supports use of cognitive-behavioral interventions to help manage the physical and mental health burden of AD. 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.