Abstract
Atopic dermatitis (AD) is a chronic skin disease now recognized to have systemic inflammatory effects which may include neuro-immunological abnormalities that are increasingly implicated in neuropsychiatric disorders. Although AD has been previously associated with anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD), longitudinal studies of both children and adults are scarce. We conducted a cohort study using a U.K. population-based electronic health records database to examine the association between AD and several major psychiatric and neurodevelopmental disorders in both children and adults. A total of 644,802 adults and 434,859 children with AD were identified using a previously validated algorithm and matched on age, practice, and index date with 2,877,347 adult and 1,983,589 pediatric controls. Using Cox regression, we found that adults with AD were at greater risk for incident depression (HR 1.17, 95% CI 1.16-1.18), anxiety (1.19, 1.18-1.20), bipolar disorder (1.14, 1.06-1.23), obsessive-compulsive disorder [OCD] (1.52, 1.43-1.62), ADHD (1.38, 1.18-1.61), and autism (1.59, 1.35-1.87) after adjusting for sex, age, and socioeconomic status. In children, the effects were mostly similar but attenuated: depression (1.09, 1.07-1.11), anxiety (1.11, 1.09-1.13), bipolar disorder (1.38, 1.13-1.70), OCD (1.34, 1.25-1.45), ADHD (1.05, 1.01-1.09), autism (1.02, 0.98-1.06). AD was not significantly associated with schizophrenia in adults (1.02, 0.92-1.14) nor children (0.87, 0.68-1.11). Similar results were observed in models excluding patients with asthma or allergic rhinitis and using logistic regression to calculate prevalent odds of outcomes. Our findings from a large population-based prospective study suggest that AD is associated with several major psychiatric and neurodevelopmental disorders among both children and adults and set the stage for further research on potential mechanisms, such as AD symptoms e.g. itch and poor sleep, stigma of chronic skin disease, or shared pathophysiology.
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