Yuki M.F. Andersen

Prevalence of comorbidity and associated risk factors in adults with atopic dermatitis

Atopic dermatitis (AD) is a common chronic skin disorder, which may persist into adulthood; however, the prevalence of comorbidities in patients with AD is not well characterized. AD is considered a systemic disorder like psoriasis, which has raised a need for data on the comorbidity profile of patients with AD, to assess the potential risks, benefits, and complications in management of patients with AD. We described the occurrence of medical and psychiatric comorbidities and associated risk factors in adults with AD compared with psoriasis and the general population.

Autoimmune diseases in adults with atopic dermatitis

Background: An increased susceptibility to autoimmune disease has been shown in patients with atopic dermatitis (AD), but data remain scarce and inconsistent. Objective: We examined the co‐occurrence of selected autoimmune diseases in adult patients with AD. Methods: Nationwide health registers were used. Adult patients with a hospital diagnosis of AD in Denmark between 1997 and 2012 were included as cases (n = 8112) and matched with controls (n = 40,560). The occurrence of autoimmune diseases was compared in the 2 groups. Logistic regression was used to estimate odds ratios. Results: AD was significantly associated with 11 of 22 examined autoimmune diseases. In addition, AD was associated with having multiple autoimmune comorbidities. Patients with a history of smoking had a significantly higher occurrence of autoimmune comorbidities compared to nonsmokers. Limitations: This study was limited to adult patients with AD. No information about AD severity or degree of tobacco consumption was available. Results from a hospital population of AD patients cannot be generalized to the general population. Conclusions: Our results suggest a susceptibility of autoimmune diseases in adult patients with AD, especially in smokers. While we cannot conclude on causality based on these data, an increased awareness of autoimmune comorbidities in patients with AD may be warranted.

Comorbidities of Atopic Dermatitis: Beyond Rhinitis and Asthma

Purpose of ReviewIn this review article, we summarize the current evidence about atopic dermatitis (AD)-associated comorbidities, beyond the traditional atopic and allergic conditions.Recent FindingsPatients with AD may have an increased risk of cardiovascular diseases, certain malignancies, autoimmune diseases, and neuropsychiatric diseases. The causes of these associations are likely multifactorial and may include genetic predispositions, systemic low-grade inflammation, environmental exposures, medication, and lifestyle and behavioral risk factors. There appears to be geographical variations in prevalence of comorbidities in patients with AD, indicating that differences in ethnicity and lifestyle factors may significantly influence the risk of certain comorbidities.SummaryThe reported comorbidities in recent literature emphasize the burden of disease in patients with AD. Early appropriate AD therapy, in combination with reduction of risk factors, may help prevention of certain comorbidities. The reported observations may generate hypotheses for future investigations in underlying risk factors for AD-associated comorbidities.

The association with cardiovascular disease and type 2 diabetes in adults with atopic dermatitis: a systematic review and meta-analysis

Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results.

Ten-year mortality is increased after hospitalization for atopic dermatitis compared with the general population, but reduced compared with psoriasis

Background: Psoriasis and atopic dermatitis (AD) are chronic inflammatory skin disorders. Mortality is increased in psoriasis, yet no studies on mortality in AD are currently available. Objective: We investigated 10‐year mortality after hospitalization for AD compared with psoriasis and the general population. Methods: Between 1996 and 2002 all Danes aged 18 years or older with a first‐time hospitalization as a result of AD or psoriasis and AD‐matched healthy control subjects were examined in nationwide registers. Multivariable (adjusted for age, sex, socioeconomic status, Charlson Comorbidity Index score, smoking, and medication) hazard ratios were estimated by Cox regression. Results: The study comprised 576 and 951 hospitalized patients with AD and psoriasis, respectively, with a maximum follow‐up time of 10 years. During the study period, there were 65 and 286 deaths among patients with AD and psoriasis. Risk of death was decreased in patients with AD versus psoriasis (hazard ratio 0.75; 95% confidence interval 0.57‐1.00), but higher than in general population control subjects (n = 5760) (hazard ratio 1.71; 95% confidence interval 1.20‐2.44). Patients hospitalized with AD died on average 8.3 years younger than control subjects. Limitations: Lifestyle may have affected the risk. Conclusions: The 10‐year mortality was significantly lower after hospitalization for AD compared with psoriasis, but increased when compared with the general population.

Gallstone Risk in Adult Patients with Atopic Dermatitis and Psoriasis: Possible Effect of Overweight and Obesity.

Adult atopic dermatitis (AD) is associated with overweight, obesity and cardiovascular diseases (CVD) in Americans, similarly to psoriasis, but no increased risk of CVD has been shown in European patients with AD. This study investigated the prevalence and risk of gallstones in adults with AD and in those with psoriasis as a proxy for obesity using nationwide data for all Danish citizens ≥ 30 years of age. Outcome was a diagnosis of gallstones. Odds ratios (ORs) were calculated by logistic regression (cross-sectional study) and hazard ratios (HRs) were estimated by Cox regression (cohort study). The study comprised 6,742 patients with AD, 53,810 patients with psoriasis, and 3,534,164 general population subjects. The prevalence of gallstones was 3.8%, 3.5% and 5.0% in the general population, AD and psoriasis patients, respectively. Adjusted ORs were 0.81 (0.71-0.92) for AD and 1.18 (1.14-1.23) for psoriasis. During follow-up, adjusted HRs were 0.72 (0.56-0.90) for AD and 1.10 (1.02-1.18) for psoriasis. The findings highlight important differences in obesity and lifestyle factors among patients with AD and those with psoriasis.

Burden of respiratory comorbidities in patients with atopic dermatitis and psoriasis

DEAR EDITOR, Atopic dermatitis (AD), a skin disease with an estimated lifetime prevalence of up to 20%, represents a major global healthcare burden. Patients with AD have a propensity to develop asthma due to a combination of genetic, immunological and environmental factors, yet descriptive studies on the impact of respiratory diseases in adults with AD are scarce. In contrast, psoriasis, another chronic inflammatory skin disease, has been associated with respiratory comorbidities such as chronic obstructive pulmonary disease (COPD), asthma and obstructive sleep apnoea (OSA). Respiratory diseases cause considerable morbidity and mortality worldwide. Quantitative assessments of the respiratory comorbidity associated with AD and psoriasis are pivotal, yet this topic remains understudied. We investigated the burden of respiratory diseases in Danish adults with AD compared with patients with psoriasis and general population controls, respectively. Utilizing data from Danish administrative registries we identified all Danish adults (aged ≥ 18 years) with an inpatient or outpatient (ambulatory) diagnosis of AD or psoriasis during the study period (1 January 1995 to 31 December 2012). Patients with AD were matched (on age and sex) with 10 general population controls. Patients were classified as having severe AD and severe psoriasis, respectively, if they received appropriate systemic therapy. A detailed description of the methodology is available on request. In total, 7937 patients with AD, 24 505 patients with psoriasis and 79 370 general population controls were identified. Asthma was highly prevalent in the AD group (18.0%), compared with patients with psoriasis (2.8%) and general population controls (2.0%) (Table 1). Logistic regression analyses yielded pronounced associations between asthma and AD, compared with psoriasis [adjusted odds ratio (aOR) 5.95, 95% confidence interval (CI) 5.38–6.59] and general population controls (aOR 8.79, 95% CI 8.08–9.56). Similar trends were found for status asthmaticus and asthma-related therapies (inhaled corticosteroids and inhaled adrenergics). COPD occurred less frequently in patients with AD than in those with psoriasis (7.4% vs. 2.6%; aOR 0.62, 95% CI 0.53– 0.72), as did use of COPD-related therapies (anticholinergics). However, in patients with severe AD, COPD risk was significantly increased compared with controls (3.5% vs. 2.1%; aOR 1.42, 95% CI 1.17–1.73). The prevalence of OSA was significantly lower in patients with AD compared with psoriasis

Differential disease burden and treatment patterns among adults with psoriasis and atopic dermatitis seen in hospital vs. private clinics

Psoriasis and atopic dermatitis (AD) are chronic inflammatory skin diseases which are prevalent in children and adults. In many countries, treatment of both conditions is managed by general practitioners, as well as dermatologists in private clinics and hospital outpatient settings. All Danish citizens have free and equal access to health care services, including general practitioners (GPs), This article is protected by copyright. All rights reserved.

Loss‐of‐function mutations in filaggrin gene and malignant melanoma: a case–control study

Loss‐of‐function mutations in filaggrin gene (FLG) have been suggested to increase the susceptibility of skin malignancies due to reduced levels of epidermal filaggrin and its degradation products, urocanic acid, which may be protective against ultraviolet irradiation.

Poor agreement in questionnaire-based diagnostic criteria for adult atopic dermatitis is a challenge when examining cardiovascular comorbidity

The association between atopic dermatitis (AD) and cardio‐metabolic risk factors is not yet established. Furthermore, no validated questionnaire‐based method of identifying adults with AD is currently available.