Depressive symptoms fluctuate with atopic dermatitis severity

Depressive episodes are closely correlated with and fluctuate with atopic dermatitis severity, according to details from a study published in the Journal of the American Academy of Dermatology.

Previous studies have shown that psychosocial symptoms of atopic dermatitis (AD) such as chronic itch, sleep deprivation and stigma related to visible lesions can all lead to decreased self-esteem and increased suicidal ideation.

Sheena Chatrath, BA, of the George Washington University School of Medicine and Health Sciences, and colleagues examined the longitudinal course and persistence of these potential depressive symptoms and how they might fluctuate with dynamic AD severity.

The study comprised 695 adult patients, most of whom were women (63.69%). At baseline, most patients reported moderate to severe itch (60.35%) as well as AD classified as mild (49.64%), moderate (31.79%) or severe (10.71%). Additionally, 7.86% of patients at baseline reported an EASI score of clear to almost clear.

Regarding the longitudinal course of depression, 65.32% of patients had minimal, 20% had mild, 8.2% had moderate, 3.88% had moderately severe and 2.59% had severe Patient Health Questionnaire-9 scores. At follow-up, the distribution was similar.

Among patients who had two follow-up appointments or more, 45.65% had persistence of depression severity classification over time, while 4.89% saw sustained improvement and 49.46% saw a fluctuation of severity.

“Difficulty concentrating was most persistent over time,” the researchers wrote. “Trouble sleeping showed greatest improvement over time, and also had the highest proportion of fluctuation over time.”

Based on further analysis, significant predictors of worse depression over time included patients who were aged 65 years or older, male sex or Hispanic, African-American or other non-white ethnicity, as well as patients with Medicaid or Medicare and those uninsured or self-pay.

“Clinicians must recognize the major mental health burden associated with AD, and offer appropriate screening, treatment and referrals,” Chatrath and colleagues wrote. “Future AD treatments should incorporate strategies for improving mental health and wellness in addition to the treatment of physical symptoms.”