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Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders

Abstract

The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.

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Contributions

AP directed the development of the manuscript text and table content, reviewed the literature related to mental health comorbidities, critically reviewed each draft, and approved the final version for submission. JCJ performed literature searches, drafted the manuscript without financial compensation, and approved the final version for submission. ELS reviewed included articles for appropriateness, critically reviewed each draft of the manuscript, and approved the final version for submission. MB reviewed the literature related to infectious comorbidities, critically reviewed each draft of the manuscript, and approved the final version for submission. JJR reviewed the literature related to neurologic, obesity, cardiovascular, and autoimmune comorbidities, critically reviewed each draft of the manuscript, and approved the final version for submission. JKB critically reviewed each draft of the manuscript and approved the final version for submission. ST reviewed included articles for appropriateness, critically reviewed each draft of the manuscript, and approved the final version for submission. JDD critically reviewed each draft of the manuscript and approved the final version for submission. SRF reviewed included articles for appropriateness, critically reviewed each draft of the manuscript, and approved the final version for submission. ARC critically reviewed each draft of the manuscript and approved the final version for submission. GS reviewed the included literature for odds ratios, reviewed and edited the manuscript, and approved the final version for submission. LE reviewed the literature related to malignancy comorbidities, critically reviewed each draft, and approved the final version as submitted.

Corresponding author

Correspondence to Amy Paller.

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Funding

This article was conceived during a 2013 roundtable in which all authors were engaged. The roundtable was supported by Valeant Pharmaceuticals North America LLC; however, there was no funding source for writing this article.

Conflict of interest

Amy Paller is a principal investigator without personal compensation for atopic dermatitis clinical trials with Incyte, LEO Pharma, and Sanofi-Regeneron, and served as a consultant for AbbVie, Dermira, Eli Lilly, Expanscience, GSK-Stiefel, Menlo Therapeutics, Novartis, Pfizer, Sanofi-Regeneron, and Valeant. Jennifer C. Jaworski was a full-time employee of Prescott Medical Communications Group, which received financial compensation for organizing the 2013 roundtable at which this manuscript was conceived. Eric L. Simpson is an investigator for AbbVie, Anacor (now part of Pfizer), Celgene, Dermira, Eli Lilly, Galderma, Genentech, LEO Pharma, Menlo Therapeutics, Pfizer, Regeneron, and Sanofi, and has served as a consultant for Amgen, Anacor, Chugai, Eli Lilly, GlaxoSmithKline, LEO Pharma, Novartis, Regeneron, Roivant, Tioga, and Vanda. Mark Boguniewicz has received research grants from Anacor (now part of Pfizer) and Regeneron, and has served as a consultant for Valeant, Pfizer, Regeneron, and Sanofi-Genzyme. John J. Russell has served as a consultant and a Speakers Bureau member for Sanofi-Aventis. Julie K. Block is a salaried executive of National Eczema Association, which has received grants and sponsorship awards from a variety of industry partners including Valeant (full list at: http://nationaleczema.org/corporate-partners/). Susan Tofte has served as a consultant for Valeant and as an Advisory Board member for Amgen, Johnson & Johnson Consumer & Personal Products Worldwide, Novartis, Sanofi-Regeneron, Pfizer, and LEO Pharma. Steven R. Feldman has served as a consultant for AbbVie, Boehringer Ingelheim, Celgene, Ely Lilly, Galderma, Janssen, LEO Pharma, Pfizer, Mylan, Novartis, Qurient, and Samsung, and a Speakers Bureau member for AbbVie, Celgene, Janssen, Eli Lilly, Novartis, and Ortho Dermatologics (formerly Valeant). He has received grants from Pfizer, Sanofi, Regeneron, AbbVie, Celgene, Novartis, and Eli Lilly. Steven R. Feldman is a founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Adele R. Clark has been a sub-investigator without personal compensation for Astellas, Medicis (now part of Valeant), Galderma, Anacor (now part of Pfizer), GSK-Stiefel, Maruho, Merz, Regeneron, and HanAll Biopharma. She has received financial compensation for her work as a consultant for Valeant Pharmaceuticals North America LLC. Lawrence Eichenfield has been a principal investigator for Astellas, Galderma, and GSK-Stiefel. He has received compensation for his work as a consultant for Valeant, Anacor (now part of Pfizer), Galderma, Promius GSK-Stiefel, and TopMD. Jeffrey D. Dunn and Gene Schwartz have no conflicts of interest that are directly relevant to the content of this article.

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Paller, A., Jaworski, J.C., Simpson, E.L. et al. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol 19, 821–838 (2018). https://doi.org/10.1007/s40257-018-0383-4

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