Atopic Dermatitis: Update on Pathogenesis and Comorbidities (original) (raw)

Atopic dermatitis and the metabolic syndrome: a cross‐sectional study of 116 816 patients

Journal of the European Academy of Dermatology and Venereology, 2019

Background: Data regarding the association between atopic dermatitis (AD) and the metabolic syndrome are controversial. Objective: To evaluate the prevalence of the metabolic syndrome and its components in a large group of patients with AD compared to a matched reference group. Methods: A cross-sectional study of AD patients diagnosed by a dermatologist between 1998 and 2016, and a matched comparison group was performed. We analyzed the association between AD and metabolic syndrome, its components, and possible complications for the entire study population, adults (age >18) and adults with moderate-to-severe AD. Results: The study included 116,816 patients with AD and 116,812 comparison enrollees. AD in the entire group of patients and in the adult patients was associated with a higher prevalence of dyslipidemia and a lower prevalence of diabetes and metabolic syndrome. Moderate and severe AD were associated, respectively, with higher prevalence rates of the metabolic syndrome (17.0% vs. 9.4%), its components (obesity: 22.2% vs. 18.6%; diabetes: 15.9% vs. 9.2%; hypertension 27.9% vs. 15.3%; dyslipidemia 47.1% vs. 28.5%, all p values <0.001), and cardiovascular morbidity (all p values <0.001). Multivariate analysis demonstrated a significant overrepresentation of the metabolic syndrome in moderate-tosevere AD (p = 0.04). Conclusions: Severely affected patients with AD may have one or more undiagnosed components of metabolic syndrome.

Is atopic dermatitis associated with obesity? A systematic review of observational studies

Journal of the European Academy of Dermatology and Venereology : JEADV, 2018

Obesity has been associated with atopic dermatitis (AD); however, the results have been conflicting. Our aim was to provide an update on current knowledge from observational studies addressing the possible association between obesity and AD. Systematic literature review was performed by identifying studies addressing a possible link between AD and overweight/obesity from PubMed, EMBASE and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. A total of 45 studies (comprising more than 90 000 individuals with AD) fulfilled the criteria and were included in the present review. The available studies revealed inconsistencies, but the majority indicated that obesity is associated with AD. Studies addressing obesity in infancy or early childhood (age < 2 years) and AD reported a positive association. From childhood into adulth...

Central Obesity and High Blood Pressure in Pediatric Patients With Atopic Dermatitis

JAMA Dermatology, 2015

IMPORTANCE Atopic dermatitis (AD) is associated with multiple potential risk factors for obesity and high blood pressure (BP), including chronic inflammation, sleep disturbance, and mental health comorbidity. Previous studies found associations between general obesity and AD. However, it is unknown whether AD is associated with central obesity and/or high BP. OBJECTIVES To determine whether central obesity and high BP are increased in pediatric AD. DESIGN, SETTING, AND PARTICIPANTS This case-control study performed in multicenter pediatric dermatology practices in the United States recruited 132 children (age range, 4-17 years) with active moderate to severe AD and 143 healthy controls from April 1, 2009, through December 31, 2012. EXPOSURES Diagnosis and severity of AD assessed by a pediatric dermatologist.

Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders

American journal of clinical dermatology, 2018

The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiov...

Association Between Metabolic Syndrome and Atopic Dermatitis in Korean Adults

Acta dermato-venereologica, 2016

Whether metabolic syndrome (MetS) and its components are risk factors for atopic dermatitis (AD) remains unclear. This study investigated the association between MetS and AD in Korean adults. Nationally representative data for 5007 Korean adults, aged 19-40 years, from the cross-sectional Korea National Health and Nutrition Examination Survey 2010-2011 were analysed. AD in female patients was associated with MetS (p = 0.02) and increased triglyceride level (p = 0.05). After adjusting for confounding factors, the odds ratio for female participants with MetS was 2.92; for central obesity (waist circumference ≥ 80 cm), 1.73; and for hypertriglyceridaemia, 2.20. In this large-scale nationwide study in Korean adults, MetS and its components (central obesity and hypertriglyceridaemia) correlated positively with the presence of AD in women.

Metabolic and inflammatory biomarkers in children with atopic dermatitis (AD): a case-control study

Egyptian Pediatric Association Gazette

Background Atopic dermatitis is characterized by impaired skin barrier and altered cutaneous innate immunity. The estimated prevalence among Egyptian children was 10–12%. Several studies suggest that it may be associated with systemic comorbidities other than the spectrum of atopy, such as metabolic syndrome and other inflammatory conditions. The aim of this study is to compare the profile of systemic conditions of diabetes, dyslipidemia, and multiple inflammatory markers in children with and without diagnosed atopic dermatitis. Methods One hundred atopic dermatitis patients and 101 normal controls were collected from outpatient clinic based on their clinical condition, both had measurement of body mass index, blood sugar, serum insulin, lipid profile, C reactive protein, and gamma-glutamyl transferase. Results Children diagnosed with atopic dermatitis had significantly higher levels of body mass index (34.7 ± 5.7 vs 26.1 ± 4.9), fasting glucose (143.2 ± 30.3 vs 100.8 ± 16.0), serum...

Association of atopic dermatitis with cardiovascular risk factors and diseases

The Journal of investigative dermatology, 2016

Epidemiological studies suggested an association between atopic dermatitis (AD) and cardiovascular disease (CVD). Therefore, we investigate associations and potential underlying pathways of AD and CVD in large cohort studies: the AOK PLUS cohort (n=1.2Mio), the GINIplus/LISAplus birth cohorts (n=2286), and the KORA F4 cohort (n=2990). Additionally, metabolomics in KORA F4 and established cardiovascular risk loci in genome-wide data on 10,788 AD cases and 30,047 controls were analyzed. Longitudinal analysis of AD patients in AOK PLUS showed slightly increased risk for incident angina pectoris (AP) (adjusted risk ratio 1.17; 95%-confidence interval 1.12-1.23), hypertension (1.04 (1.02-1.06)) and peripheral arterial disease (PAD) (1.15 (1.11-1.19)) but not for myocardial infarction (MI) (1.05 (0.99-1.12) and stroke (1.02 (0.98-1.07)). In KORA F4 and GINIplus/LISAplus, AD was not associated with cardiovascular risk factors (CVRFs) and no differences in metabolite levels were detected. T...

Atopic Dermatitis – Associated Immune Dysfunction

Romanian Journal of Pediatrics, 2016

The immune system shows a complex role to defend the body in response to "non-self" antigens, respond abnormally to antigens allergens (hypersensitivity and autoimmunity) and shows immune tolerance by lack of reactivity to its own structures (self). Aim. The aim of this study is to demonstrate that in atopic dermatitis immune deficiency influences the development of atopy, disease severity and comorbidities. Material and methods. Following medical record review, 135 cases diagnosed with AD were included in the study. Statistical analysis was performed using SPSS v20 for determining the frequency and testing the hypotheses, for p < 0.05, by t tests and One-Way ANOVA. Results. Of the 135 cases, 51.9% were male children and 48.1% female children aged 1 month to 127 months with a mean of 26.21. According to total serum IgE level, 64.4% of patients had elevated IgE levels, 35.6% normal levels. According to the SCORAD, children had mild AD in 20.7% of cases, moderate in 70.4%, and severe in 8.9%. IgA deficiency was found for 48.1% of cases, and for 51.9% normal. IgG deficiency was found in 38.5% of cases. The independent samples t tests showed statistical significant demonstrating correlations between IgE level and IgA immune deficiency, between SCORAD and IgG and IgA immune deficiency. Atopic march is influenced by elevated IgE, IgA and IgG immune deficiency, p <0.05. Conclusions. Atopy in AD can be influenced by complex factors, both internal and environmental, but this remains a controversial topic. External factors acting on a background genetically predisposed to atopy trigger the manifestation of AD.

Clinical correlations of recent developments in the pathogenesis of atopic dermatitis

Anais Brasileiros de Dermatologia, 2008

Atopic dermatitis is a chronic inflammatory skin disease with a steadily increasing prevalence affecting 10-20 % of infants and 1-3% of adults globally. It is often the first clinical manifestation of atopic disease preceding asthma and allergic rhinitis. Probably half of the children with atopic dermatitis develop some other form of atopic disease later in life. The pathogenesis involves a complex interplay of factors including genetic predisposition due to altered immune or skin barrier function, interactions with the environment such as food and allergen exposures, and infectious triggers of inflammation. In this review, we summarize the recent advances in understanding the contribution of different factors in the pathophysiology of atopic dermatitis and how insights provide new therapeutic potential for its treatment.