Dr Jonathan Silverberg Sheds Light on the Shift in Comorbidities Associated With Atopic Dermatitis

In order to properly help patients manage their disease, it is critical for clinicians to recognize the differences in prevalence, severity, and persistency of atopic dermatitis among different demographics, said Jonathan Silverberg, MD, PhD, MPH.

In order to properly help patients manage their disease, it is critical for clinicians to recognize the differences in prevalence, severity, and persistency of atopic dermatitis among different demographics, said Jonathan Silverberg, MD, PhD, MPH.

Transcript:

What trends did your study detect regarding atopic dermatitis comorbidities and how have they changed over time?

This isn't a very interesting story and, I think, one that we need more research on. But for certain comorbidities, there really weren't any major changes over time. For example, asthma, food allergies, or having atopic disease in general. Interestingly, when it came to hay fever, there seemed to be a little bit of a decrease amongst those patients with atopic dermatitis. And I should say, even without atopic dermatitis as well, but of course it is more common to see hay fever in the atopic, dermatitis patient population. So, for some comorbidities, there were no major differences.

Similarly, when we looked at depression, sadness, and attention deficit disorders, we didn't see any major interactions over time. But what we did see is that the prevalence, particularly of attention deficit disorders, so ADD and ADHD [attention-deficit/hyperactivity disorder], increased in those with atopic dermatitis, as well as those without atopic dermatitis. But, again, the effect size was greater in the atopic dermatitis patient population.

Conversely, we actually saw a little bit of a lower rate of depression and sadness over time in the atopic dermatitis patients and the non-atopic dermatitis patients. So, part of this may be related to better recognition of these disorders and better management, potentially, for that. It may also represent a variety of other biological or environmental factors that we can't fully account for in this type of population-based research.

How can your results aid physicians in helping their young patients manage atopic dermatitis?

Well, I think, first and foremost, to recognize that atopic dermatitis is the most common chronic disease of childhood. It's a strong statement. I think sometimes a lot of clinicians don't recognize how common atopic dermatitis really is and how commonly it can be debilitating for patients. So, even just recognizing this as a major player in the chronic disease arena, particularly in children, but even in adults, is a very important step from our understanding of the disease.

I think recognizing some of these particularly high risk groups in terms of prevalence, severity, and disease persistency, particularly in African American children and Hispanic American children I think is very, very important. And it really raises important questions about if we are doing enough to address the management of the disease in these vulnerable populations.

But, I think what perhaps is more important than anything else is recognizing that with the diversification of the population, there needs to be a frameshift. One, in terms of resource allocation, but also, as clinicians, in terms of how we assess the skin. Are we appropriately assessing a topic dermatitis and skin of color? Are we properly diagnosing it? Are we properly assessing the severity? Are we properly managing it? Or are we just trying to use a one-size-fits-all approach that may have been adequate 30 years ago, but certainly isn't now with a much more diverse population?

So, I think there's a lot of different implications at the high level about us rethinking our understanding of atopic dermatitis, particularly across all different types of skin types.