Systemic Manifestations of Atopic Dermatitis: A Systematic Review

Abstract

Background: Atopic dermatitis (AD) is known to be associated with other allergic diseases, which often develop later in life in a serial fashion. This progression is termed the “atopic march” and is considered the classical presentation of atopic disease. However, recent evidence suggests that this paradigm may not hold true for a significant portion of patients with these conditions. Not only is the timing of development likely more complex than previously believed, the comorbidities associated with AD are possibly more numerous and varied.Methods: This two-step systematic review involved a targeted search of PubMed and EMBASE with an additional hand search of key journals. The terms “atopic dermatitis” and “atopic eczema” were searched in conjunction with multiple keywords representing the concept of systemic nature of disease. All titles and abstracts were subsequently screened for relevance to the research question.Results: This review’s evidence supports an association between AD and other atopic diseases. However, it also suggests that the classical paradigm of the “atopic march” does not apply to all patients with atopic dermatitis. There appears to be a significant association between AD and multiple neuro-psychiatric comorbidities, particularly ASD and ADHD. Additional themes supported by lower-level evidence are increased risk of cardiovascular disease, decreased risk of type I diabetes, and increased risk of multiple malignancies in patients with AD. Conclusion: There is likely a diversity of phenotypes for patterns of allergic disease. Both positive and negative associations identified in this systematic review suggest that AD is condition with varied systemic manifestations.