Association Of Atopic Dermatitis Research Articles

Genotype Associations with the Different Phenotypes of Atopic Dermatitis in Children.

This study deals with detecting the associations of atopic dermatitis' (AD) phenotypes in children: alone or combined with seasonal allergic rhino-conjunctivitis (SARC) and/or perennial allergic rhinitis (PAR), and/or with bronchial asthma (BA) with single nucleotide polymorphisms (SNP) of filaggrin (FLG), thymic stromal lymphopoietin (TSLP) and orsomucoid-like-1 protein 3 (ORMDL3) genes. Male and female pediatric patients aged from 3 to 18 years old were recruited into the main (AD in different combinations with SARC, PAR, BA) and control groups (disorders of digestives system, neither clinical nor laboratory signs of atopy). Patients were genotyped for SNP of rs_7927894 FLG, rs_11466749 TSLP, rs_7216389 ORMDL3 variants. Statistically significant associations of the increased risk were detected of AD combined with SARC and/or PAR and AD combined with BA (possibly, SARC and/or PAR) with C/T rs_7927894 FLG and T/T rs_7216389 ORMDL3 genotypes. Genotype C/C rs_7927894 FLG significantly decreases the risk of AD combined with SARC and/or PAR by 2.56 fold. Several genotypes' associations had a trend to significance: C/C rs_7216389 ORMDL3 decreases and C/T rs_7216389 ORMDL3 increases the risk for developing AD alone phenotype; A/G rs_11466749 TSLP decreases the risk of AD combined with BA (possibly, SARC and/or PAR) phenotype development.

Association of atopic dermatitis with an increased risk of systemic lupus erythematosus: A systematic review and meta-analysis.

Context:Previous studies on the association between atopic dermatitis (AD) and systemic lupus erythematosus (SLE) have yielded inconsistent results.Aims:To investigate the relationship between atopic dermatitis and systemic lupus erythematosus.Settings and Design:Systematic review and meta-analysis.Materials and Methods:A systematic review was conducted on EMBASE and MEDLINE databases from inception to March 2020 using a search strategy that consisted of terms related to AD and SLE. Eligible study must be either cohort or case-control study. For cohort studies, they must include patients with AD and comparators without AD, then follow them for incident SLE. For case-control studies, they must include cases with SLE and controls without SLE and examine their prior history of AD.Statistical Analysis Used:Meta-analysis of the studies was performed using a random-effect, generic inverse variance method to combine effect estimate and standard error. Funnel plot was used to assess publication bias.Results:A total of 21,486 articles were retrieved. After two rounds of review by three investigators, six case-control studies were qualified for the meta-analysis. The case-control study meta-analysis found a significantly increased odds of SLE among patients with AD with the pooled odds ratio of 1.46 (95% CI, 1.05–2.04).Conclusions:A significant association between AD and increased odds of SLE was observed by this systematic review and meta-analysis.

Association of Atopic Dermatitis with Dyslipidemia in Adolescents: A Cross-Sectional Study

Association of Atopic Dermatitis with Dyslipidemia in Adolescents: A Cross-Sectional Study

Evaluation of lens clarity in children with atopic dermatitis: A densitometric analysis with Pentacam.

The association of atopic dermatitis (AD) with a wide variety of ocular complications is known; however, there is no study in the literature that measured lens densitometry in pediatric patients with AD. This study aimed to investigate lens densitometry in children with AD. In order to examine ocular complications in AD, 31 pediatric patients (13 males, 18 females; mean age 12 ± 3 years) with AD and 20 healthy children (9 males, 11 females; mean age 12 ± 2 years), who presented to the dermatology clinic of Istanbul Medipol Mega University between December 2018 and May 2019 were included in this study. The diagnosis of AD was based on the UK Working Party's Diagnostic Criteria for AD. Patients receiving inhaler and systemic steroids were excluded from the study. All children were examined by the same dermatologist and ophthalmologist. The mean values of best-corrected visual acuity, refractive error, and axial length were similar between both groups (P > .05). The lens densitometry values of zone 1, zone 2, and zone 3, as well as the average lens densitometry measurements were found statistically significantly higher in children with AD compared to the controls (P < .05 for all). This is the first study to demonstrate an increase in treatment-independent lens densitometry in children with AD.

Mutations of filament-aggregating protein gene in Romanian children diagnosed with atopic dermatitis.

Association of atopic dermatitis (AD) and several mutations of various genes of the immune system, in particular filament-aggregating protein gene (FLG) has been investigated in many studies. The association between defective FLG and AD in the Romanian population has not been assessed or published. The present study focused on the genetic background of AD, aiming to assess the prevalence of FLG mutations in Romanian patients with AD. Genetic background of AD was tested for common FLG-mutations: R501X, 2282del4, S3247X and R2447X. The study involved 48 Romanian Caucasian children aged between two months and six years diagnosed with AD, and 48 healthy volunteers; DNA extraction involved 50% of the patients to give samples by using buccal swabs and 50% by collection of whole blood samples. Genetic predisposition was evaluated based on family history, atopy history and profilaggrin genotyping. DNA extracted from blood samples was adequate to study FLG mutations, although no mutation was identified. Genetic factors do not have a unique critical role in AD; therefore, environmental factors unquestionably play an important role in this disease, but the clear-cut part that these factors trigger toward increasing the risk of AD in childhood is still obscure.

Smoking and risk of adult-onset atopic dermatitis in US women

Smoking and risk of adult-onset atopic dermatitis in US women

Association of atopic dermatitis with suicide risk among 788,411 adolescents: A Korean cross-sectional study

BackgroundAtopic dermatitis (AD) is known to negatively influence the mental health of patients. However, only a few studies have explored the influencing factors for psychiatric problems among adolescents with AD. ObjectiveTo assess the association of AD and suicidal behaviors among adolescents by analyzing data from the 3rd through the 13th annual Korean Youth Risk Behavior Web-based Surveys (completed from 2007 to 2017). MethodsSurvey data were obtained from a stratified, multistage, clustered sample. Students self-reported AD if they had received a diagnosis of AD by a physician. Influencing factors for suicidal behaviors were tested by logistic regression models. ResultsA total of 788,411 adolescents completed the survey. The proportion of participants with AD was 22.2%. Those reporting suicide ideation and suicide attempts were 19.0%, and 4.5%, respectively. Compared with adolescents without AD, those with AD were more likely to be female, to skip breakfast less frequently, to exercise less frequently, to drink less alcohol, and to not be current smokers and were statistically significantly more likely to have negative mental health states. In the multivariable model, perceived unhappiness and suicidal ideation were the strongest influencing factors for suicidal ideation (adjusted odds ratio, 4.90; 95% CI, 4.31-5.57) and for suicidal attempts (adjusted odds ratio, 48.01; 95% CI, 42.69-53.09), respectively. ConclusionAdolescents with AD had a meaningful prevalence of suicidal behaviors. Although further research is needed to clarify this association, adolescents with AD with influencing factors for negative mental health state may need intervention from practitioners who use a multidisciplinary team approach to prevent suicide.

Association of Atopic Dermatitis With Bacterial, Fungal, Viral, and Sexually Transmitted Skin Infections.

Atopic dermatitis (AD) is associated with altered skin barrier, microbiome, and immune dysregulation that may increase risk of skin infections. The aim of the study was to determine whether AD is associated with skin infections and related outcomes. Data from the 2006 to 2012 National Emergency Department Sample were analyzed, including an approximately 20% sample of all US emergency department (ED) visits (N = 198,102,435 adults or children). Skin infections were increased in ED visits of adults (7.14% vs 3.76%) and children (5.15% vs 2.48%) with AD. In multivariable logistic regression models, AD was associated with significantly higher odds of skin infection in adults (adjusted odds ratio [95% confidence interval] = 1.93 [1.89-1.97]) and children (2.23 [2.16-2.31]). Pediatric and adult AD were associated with significantly higher odds of carbuncle/furuncles, impetigo, cellulitis, erysipelas, methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections, molluscum contagiosum, cutaneous warts, herpes simplex and zoster viruses, eczema herpeticum, dermatophytosis, and candidiasis of skin/nails and vulva/urogenitals. Adults with AD had significantly higher odds of genital warts (1.51 [1.36-1.52]) and herpes (1.23 [1.11-1.35]). Skin infections were associated with US $19 million excess annual costs of ED care in persons with AD. Atopic dermatitis patients had higher odds of multiple bacterial, viral, fungal, and sexually transmitted skin infections.

Association of atopic dermatitis with inflammatory bowel disease: A systematic review and meta-analysis

Background: Altered microbiota of the gastrointestinal tract have been implicated in both atopic dermatitis (AD) and inflammatory bowel disease (IBD). However, the relationship between AD and IBD has been unclear. Objectives: The objective of this study was to systemically assess the evidence on the association of AD with IBD. Methods: We conducted a systematic review and meta-analysis of observational studies on the association of AD with IBD. We searched MEDLINE, Embase, CENTRAL, Web of Science, and Airiti Library from inception to May 24, 2019, for relevant studies. The outcomes were the odds and risk of Crohn's disease (CD) and ulcerative colitis (UC) in patients with AD. Results: We included five case–control studies and one cohort study. We identified significant associations of AD with prevalent CD (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.11–2.15) and UC (OR: 2.49, 95% CI: 1.04–5.98). One Danish cohort study found no increased risk for incident CD (hazard ratio [HR]: 0.69, 95% CI: 0.34–1.30) and UC (HR: 0.94, 95% CI: 0.61–1.43) in patients with AD. Conclusion: The current limited evidence supports an association of AD with prevalent IBD. Digestive symptoms in patients with AD, for example, chronic diarrhea and abdominal pain, shall not be overlooked, and gastroenterology counseling may be needed.

Association of atopic dermatitis with vitiligo: A systematic review and meta-analysis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with multiple immune-mediated disorders. A comprehensive meta-analysis assessing the prevalence or risk of vitiligo in AD patients is lacking. To compare the prevalence and assess the risk of vitiligo in patients with AD by performing a meta-analysis of observational studies. PubMed, Scopus, and Cochrane databases were systematically searched until August 25, 2019, following the PRISMA guidelines. Published English-language articles including case-control, cross-sectional, or cohort studies that reported either odds or risk of vitiligo in AD patients were included. Full-text review and study assessment were performed by the two authors independently. Random-effects meta-analysis model was used to calculate the odds ratio (OR) and risk ratio (RR) with the corresponding 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale. Seven studies with a total of 1540688 unique AD patients were included. The random-effects meta-analysis of case-control and cross-sectional studies showed a significant association of AD with vitiligo (OR, 3.21; 95% CI, 1.90-5.43). Subgroup analyses also showed a significant association for both adult AD (OR, 4.46; 95% CI, 1.65-12.07) and childhood AD (OR, 2.83; 95% CI, 1.53-5.25). Pooling of the results of 2 cohort studies showed an increased risk of vitiligo in patients with AD (RR, 1.64; 95% CI, 1.27-2.13). Results from this study support an association of AD with vitiligo. Exploration of possible mechanisms responsible for this association could be important to develop proper treatment approaches for the affected patients.

Association of Atopic Dermatitis With Sleep Quality in Children

To examine whether there is an association of active atopic dermatitis (AD) with sleep duration and sleep quality over multiple time points during childhood.A sample from a longitudinal cohort study of 13 988 children from Avon, United Kingdom, was studied.Data were collected from 1990 to 2008, and AD was determined by a standardized question about flexural dermatitis. Multiple assessments were conducted with the cohort from 1 year of age to age 16, and questions were answered by the mother, except at age 16. Sleep duration was measured as parent report or self-report of time the child usually went to sleep and usually woke up. Sleep disturbance was measured by the child’s nighttime awakenings, regular experience of early morning awakenings, difficulty falling asleep, and nightmares over the past year. Cross-sectional linear and logistic regressions were used for comparing sleep outcomes between children with and without AD; mixed effects models were used for longitudinal analyses for repeated measures of exposures, outcome, and time-varying covariates.Of the study sample, 4938 children (35.3%) met the study criteria for AD. The median duration of follow-up for the cohort was 11 years (interquartile range: 5–14 years). Sleep duration between children with and without AD were similar; and no differences were found by severity of AD in the adjusted model. Children with AD, however, had nearly 50% increased odds of sleep disturbances, compared with children without AD. In addition, children with and without comorbid asthma or allergic rhinitis had worse sleep disturbance with more-severe AD.Although the investigators of the study found no differences in sleep duration between children with and without AD, children with worse AD severity or with comorbid asthma or allergic rhinitis had worse sleep quality outcomes.This study emphasized the sleep quality impairments that pediatric patients might face with AD throughout childhood by leveraging the repeated assessments in their longitudinal birth cohort. Although researcher in cross-sectional and clinical studies have also found similar results with AD and sleep duration and sleep quality, the study adds a population health perspective to the scientific discussion of sleep quality among these children. The findings of the study add to the importance of needing to develop clinically relevant and efficient ways of identifying and ameliorating potential deficits in sleep quality among pediatric AD patients.

Association of atopic dermatitis with increased risk of anaphylaxis to egg and milk

Association of atopic dermatitis with increased risk of anaphylaxis to egg and milk

Association of atopic dermatitis with obesity via a multi-omics approach: A protocol for a case-control study.

Introduction:Several studies have found that obesity is associated with atopic dermatitis (AD); however, the mechanisms underlying the association are largely unknown. This study aims to assess the association of AD with obesity in the Korean population and verify its mechanism via a multi-omics analysis.Methods and analysis:A case–control study will be conducted in the Republic of Korea. A total of 80 subjects, aged 4 to 12 years, matched for age and sex, with body mass index at or above the 85th percentile or at or below the 25th percentile, will be included. Subjects will be assigned to the following 4 groups: obese/overweight with AD, normal/underweight with AD, obese/overweight control, and normal/underweight control. Serum metabolome and immune biomarkers, as well as fecal metabolome and microbiome biomarkers, will be analyzed. Serum eosinophil cationic protein, total serum Immunoglobulin E (IgE), and specific IgE will be analyzed to assess allergic tendency. The SCORing of AD index, the children's dermatology life quality index, body composition analysis, and the Korean gastrointestinal symptom rating scale will be obtained to assess the disease status and severity of the subjects.Discussion:The findings of this study are expected to provide evidence of an association between AD and obesity via a gut microbiome-metabolome-immune mechanism. Therefore, it may improve future management strategies for AD.Trial registration:This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0003630).

More than skin deep: the systemic nature of atopic dermatitis.

Atopic dermatitis is a worldwide prevalent chronic inflammatory skin disease. Although primarily recognized as a disease of children, there is increasing evidence suggesting that it is more common in adults than previously thought. Both immune dysregulation and cutaneous barrier dysfunction are involved in the pathogenesis of the disease, although the exact mechanisms are still unclear. The concept of atopic dermatitis as a biphasic Th1-Th2 disease is changing, as recent evidence supports systemic activation of other multiple Th-cell subsets. Atopic dermatitis has been associated with an increasing number of comorbidities, possibly sharing some common pathological mechanisms. The atopic march is well known and represents the natural progression of atopic diseases in a considerable number of patients, usually starting with the development of atopic dermatitis followed by other atopic conditions, such as asthma and allergic rhinitis. Association of atopic dermatitis with cardiovascular disease, autoimmune diseases, as well as cutaneous and extracutaneous infections have been increasingly reported, although the link is not yet clear. Furthermore, the association between atopic dermatitis and neuropsychiatric conditions has also been widely studied, with an increased risk of mental health disorders strongly influenced by sleep disorders. Altogether, these associations contribute to the burden of atopic dermatitis, which increases the need for a more focused therapeutic approach that includes prevention or early diagnosis and treatment of comorbidities that may arise. This review explores the recent associations with atopic dermatitis and the possible underlying mechanisms involved, which supports the concept of atopic dermatitis as a systemic disease.

Association of Atopic Dermatitis With Sleep Quality in Children

Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.

The Prevalence of Atopic Dermatitis and Chronic Spontaneous Urticaria are Associated with Parental Socioeconomic Status in Adolescents in China.

The association of atopic dermatitis and chronic spontaneous urticaria with socioeconomic status has been little studied. The aim of this study was to investigate the prevalence of skin diseases and their association with socioeconomic status in adolescents in China. A cross-sectional study was conducted at Central South University, Changsha, China. All newly enrolled students underwent dermatological examination and completed a survey. Socioeconomic status was measured in terms of parental education level and income. Two-level logistic regression models were used. A total of 8,226 students consented to participate. On dermatological examination, moderate to severe acne (10.2%) had the highest prevalence, followed by chronic spontaneous urticaria (2.7%), atopic dermatitis (2.5%), and tinea (1.7%). Socioeconomic status was positively associated with the prevalence of chronic spontaneous urticaria (ptrend = 0.001) and atopic dermatitis (ptrend = 0.0094). Tinea was inversely associated with socioeconomic status (ptrend = 0.025). Higher parental socioeconomic status was associated with higher risk of atopic dermatitis and chronic spontaneous urticaria, but lower risk of tinea.

Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis

Atopic dermatitis (AD) has been associated with anxiety and depression, but the magnitude of the alleged association is unknown. To perform a systematic review and meta-analysis of the association between AD in children and adults and, respectively, depression, anxiety, and suicidal behavior. The medical databases PubMed, Embase, and PsychINFO were searched. There was a significant association between adult AD and, respectively, depression (pooled odds ratio [OR], 2.19; 95% confidence interval [CI], 1.87-2.57) and anxiety (pooled OR, 2.19; 95% CI, 1.75-2.73). AD was also associated with depression in children (pooled OR, 1.27; 95% CI, 1.12-1.45); few data were available for anxiety. A positive association was found between AD in adults and adolescents and suicidal ideation (pooled OR, 4.32; 95% CI, 1.93-9.66). Only a few studies examined the risk of completed suicide,but the majority showed a positive association between completed suicide and AD. Included studies used different definitions of depression and anxiety, and few studies examined the severity of AD. Depression, anxiety, and suicidal ideation should be considered by doctors when treating patients with AD. Because AD disease improvement appears to reduce these risks, this should be a priority.

Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults

BackgroundAtopic dermatitis (AD) has been associated with multiple comorbid extracutaneous and systemic disorders. The relation between AD severity and disease comorbidities is complex and not fully understood. ObjectiveTo determine the complex relation between AD severity and comorbidities. MethodsA cross-sectional US population-based study of 8,217 adults who were participants in a nationally representative internet health panel was performed using a structured questionnaire. A diagnosis of AD was determined using modified United Kingdom Working Party Criteria for AD (n = 602). AD severity was assessed using Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and self-reported global AD severity. Logistic regression and structural equation models were used to explore associations of AD with self-reported allergic, cardiometabolic, anxiety and depression, and autoimmune disease. ResultsIn multivariable regression models controlling for sociodemographics, AD was associated with higher odds of asthma (adjusted odds ratio [OR] 2.09, 95% confidence interval [CI] 1.71–2.55), hay fever (OR 4.31, 95% CI 3.27–5.69), food allergy (OR 2.07, 95% CI 1.54–2.77), anxiety and depression (OR 2.34, 95% CI 1.91–2.87), autoimmune disease (OR 3.05, 95% CI 2.31–4.03), obesity (OR 1.37, 95% CI 1.13–1.67), diabetes (OR 1.52, 95% CI 1.16–1.99), high blood pressure (OR 1.46, 95% CI 1.18–1.80), and heart disease (OR 1.94, 95% CI 1.40–2.70) compared with controls (P < .01 for all). All these associations were significant in mild and/or moderate disease, with even stronger effects in severe AD. Results of structural equation models showed direct effects of moderate to severe AD on food allergy, anxiety and depression, and diabetes, direct and indirect effects on obesity, and indirect effects on high blood pressure and heart disease. ConclusionThere is a strong relation of AD severity to allergic, autoimmune, and cardiovascular comorbidities.

Association of atopic dermatitis with depressive symptoms and suicidal behaviors among adolescents in Korea: the 2013 Korean Youth Risk Behavior Survey

BackgroundAtopic dermatitis (AD) is a chronic skin disease which has been known to negatively influence the mental health of patients. However, only a few studies have explored the prevalence of psychiatric problems among AD patients, particularly among adolescents. In this study, we aimed to assess the association of AD with depressive symptoms and suicidal behaviors among adolescents by analyzing data from the 2013 Korean Youth Risk Behavior Survey, a nationwide web-based survey.MethodsData from 72,435 adolescent middle and high school students in Korea were analyzed. Students self-reported AD diagnosed by a doctor and yes-or-no answers to questions about depressive symptoms and suicide ideation, suicide planning, and suicide attempts were analyzed. Relationships between AD and depressive symptoms or suicidal behaviors were tested by logistic regression models after controlling for potential confounding factors.ResultsThe proportion of adolescents who had AD was 6.8%. The proportion of adolescents reporting depressive feelings was 31.0%, suicide ideation was 16.3%, suicide planning was 5.8%, and suicide attempts was 4.2%. Compared to adolescents without AD, adolescents with AD were significantly more likely to experience depressive feelings (odds ratio [OR]: 1.27, 95% confidence interval [Cl]: 1.19-1.36), suicide ideation (OR: 1.34, 95% Cl: 1.24-1.45), suicide planning (OR: 1.46, 95% Cl: 1.32-1.65), and suicide attempts (OR: 1.51, 95% Cl: 1.33-1.72). In the multivariate model, the relationships between AD and suicide ideation (OR: 1.26, 95% Cl:1.16-1.36), suicide planning (OR: 1.28, 95% Cl:1.14-1.44), and suicide attempt (OR: 1.29, 95% Cl:1.13-1.49) were statistically significant.ConclusionAdolescents who have AD are associated with a higher prevalence of depression symptoms and suicidal behaviors. Adolescent AD patients may need interventions from clinicians and caregivers that use a holistic approach to prevent psychological comorbidities, although further research is needed to clarify this relationship.

Atopic Dermatitis Disease Complications.

This chapter will describe infectious complications of atopic dermatitis, including bacterial, viral, and fungal infections and the evolving understanding of the relationship between atopic dermatitis and infectious disease. The underlying immunological dysregulation and poor skin barrier function associated with atopic dermatitis not only increases the likelihood of infectious complications, but also lends atopic dermatitis skin vulnerable to flares induced by environmental triggers. Thus, this chapter will also highlight the impact of common external environmental agents on precipitating flares of disease. Lastly, this chapter will discuss complications that can arise from treatments and the association of atopic dermatitis with more serious conditions such as lymphoma.