Mental Health Comorbidities in Atopic Dermatitis: Essential Insights for Primary Care

Atopic dermatitis is far more than a skin condition. Beneath and behind the visible rash for many who are affected lies a profound psychosocial burden that affects individuals across the lifespan, shaping their self-esteem, relationships, and life choices in ways that persist long after the skin clears.

©BenStudioPRO/stock.adobe.com

This is the first in a series of 6 short articles that highlight specific aspects of the emotional burden of atopic dermatitis from youth to older age, all with the primary care practioner in mind.

Depression and anxiety affect as many as 1 in 4 people with AD,1 yet this mental health dimension often goes unaddressed in clinical encounters focused on skin clearance.

Primary care providers are uniquely positioned to recognize and address this hidden crisis. Up to 80% of atopic dermatitis is managed in primary care,2 making PCPs the front-line clinicians who can identify patients at risk and intervene early. As one expert notes, AD is not just "another rash on the schedule. It could be the reason that patient doesn't leave the house."3 Understanding the mental health implications of AD, and knowing when and how to intervene, can literally change a patient's life trajectory.

Scope of the Problem

The psychiatric burden of AD has been well-documented in recent research, yet it remains underrecognized in clinical practice. "We know that children and adolescents with AD have about a 1.5-fold increased risk of anxiety and depression compared to those without AD, while adults with AD face an even higher risk of 2 to 3 times greater," Jennifer LeBovidge, attending psychologist in the division of immunology at Boston Children's Hospital and assistant professor of psychology in the department of psychiatry at Harvard Medical School, said in a recent interview with Patient Care.

Understanding the prevalence of mental health comorbidities and the specific risk factors that predict anxiety and depression enables clinicians to identify vulnerable patients who need more comprehensive support.

By the Numbers

• Depression and anxiety affect as many as 1 in 4 people with AD1
• The burden is particularly pronounced among adolescents, with significantly greater impact on quality of life and psychosocial interaction compared to younger children.4
• Patients with early-onset AD report profound, lifelong effects on self-esteem, relationships, and career choices that persist well into adulthood.5
• Nearly 1 in 10 US adults have eczema, with 18% experiencing multiple eczema conditions, compounding the psychological impact.6

Key Risk Factors for Anxiety and Depression

A comprehensive study has identified several independent risk factors that predict mental health comorbidities in AD patients.1 Clinicians should be especially vigilant when these factors are present:

• Pruritus severity - The single strongest predictor of anxiety and depression in AD
• Sleep disorders - Creates a vicious cycle where disrupted sleep worsens both skin symptoms and psychological distress
• Lower education level - Associated with reduced access to specialized care and fewer coping resources
• Multiple comorbidities - The cumulative burden of other chronic conditions compounds psychological distress
• Disease severity - Moderate to severe AD carries the highest risk for psychiatric comorbidities

These risk factors should trigger more in-depth assessment of mental health status during routine visits. Even patients with currently well-controlled skin disease may carry psychological scars from years of suffering that warrant attention and support.

NEXT: The Lifespan Impact of Atopic Dermatitis