Introduction

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with systemic T-helper 2 activation and respiratory comorbidities, e.g. asthma and rhinitis. Concern exists regarding potential for poorer COVID-19 outcomes in AD patients, though previous studies had mixed findings [1,2,3,4,5]. We investigated the relationship between AD and COVID-19 outcomes in adults.

Methods

The study was approved by the George Washington University (GWU) institutional review board. We retrospectively analyzed data from GWU medical records for patients treated for SARS-CoV-2. Sociodemographic traits were compared between those with vs. without AD and severe-critical vs. mild-moderate COVID-19 using chi-squared and student’s t test for categorical and continuous variables, respectively (Table 1). Binary logistic regression models were constructed with COVID-19 outcomes as dependent variables (acuity level of initial medical contact, hospitalization, hospitalization duration, COVID-19 symptom severity, requirement of supplemental oxygen therapy, mortality and long-term morbidity) and AD as the independent variable. Multivariable models adjusted for socio-demographics and comorbidities. Crude and adjusted odds ratio (OR) and 95% confidence intervals (CI) were estimated.

Table 1 Sociodemographic and other health-related associations related to diagnosis of atopic dermatitis
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Results

Overall, 430 adults were identified with confirmed SARS-CoV-2 and a diagnosed skin disease, including 48 (11.2%) with diagnosed AD. Most (81.25%) AD patients were non-White. There were no significant differences of age, BMI, sex, race, insurance coverage, malignancy or AIDS diagnoses or immunosuppressant use between those with vs. without AD. Patients with vs. without AD had lower rates of diabetes mellitus (DM; 12.50 vs. 25.65%, P = 0.0449) and higher rates of obstructive lung disease (37.50 vs. 18.06%, P = 0.0016). COVID-19 severity was associated with older age, higher BMI, non-White race, immunosuppressant use, obstructive lung disease, hypertension, chronic kidney disease and DM.

Among SARS-CoV-2 positive adult patients, those with vs. without AD had similar COVID-19 clinical outcomes. In fully adjusted models, diagnosed AD had similar odds of hospitalization (adjusted odds ratio [95% confidence interval]: 0.51 [0.20–1.35]), acute level of care at initial medical care (0.67 [0.35–1.30]), severe-critical SARS-CoV-2 (0.82 [0.29–2.30]), requirement of supplemental non-mechanical oxygen therapy (1.33 [0.50–3.58]), extended hospital stay (2.24 [0.36–13.85]), lingering COVID-19 symptoms (0.58 [0.06–5.31]) and COVID-19 death (0.002 [< 0.001– > 999]) compared to those without AD. Similar results were observed in unadjusted models (Table 2).

Table 2 Association of atopic dermatitis with COVID-19 severity and hospitalization
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Discussion

These findings are consistent with studies that found no association of AD with COVID-19 morbidity. AD patients may be more susceptible to acquiring SARS-CoV-2 infection [3], though findings are inconclusive [5]. Current evidence indicates that AD patients are not at increased risk of mechanical ventilation [3, 4], hospitalization [2], longer hospital stay [4], intensive care unit admission [4] or death [2, 4]. In one retrospective study, AD was inversely associated with COVID-19 hospitalization [1]. We further demonstrate that AD is not associated with various other COVID-19 outcomes, including supplemental oxygen therapy, lingering symptoms and acuity level of initial care.

Study strengths include examination of multiple COVID-19 outcomes and controlling for confounders in multivariable analyses. Limitations include small sample size of AD patients, recruitment from a single metropolitan academic center, racial homogeneity and lack of stratified analysis by SARS-CoV-2 variants or AD features. Future studies with larger samples can further elucidate potential associations between AD and COVID-19.