According to a prospective, real-world, clinical cohort study, the systemic treatment of atopic dermatitis (AD) can lead to an increased relief of skin symptoms as well as improved mood.
Utilizing data from SwedAD, a Swedish national registry of patients with AD on systemic treatment between June 2017 and August 2021, a total of 120 patients were started on dupilumab, methotrexate, or ciclosporin. These patients were followed at 6 and 12 months for the primary outcome of depressive symptoms using the Montgomery–Åsberg Depression Rating Scale–self-report (MADRS-S).
The six-month follow-up data revealed that 59 patients (48 on dupilumab, 10 on methotrexate, and one on ciclosporin) reported remarkable improvement in all nine depressive symptoms in MADRS-S. The most significant of these was improved sleep.
Looking at the secondary outcome of depressive symptoms, which included the Eczema Area and Severity Index (EASI) score, Patient-Oriented Eczema Measure (POEM), the Dermatology Life Quality Index (DLQI), and pruritus visual analog scale/numeric rating scale (VAS/NRS), researchers found a strong correlation between all of these and the MADRS-S score.
Marissa Joseph, MD, a pediatric dermatologist at the University of Toronto, Ontario, Canada, and moderator in the study, stated,
She goes on to state that, “exploring those types of symptoms is something we need to do more of, and the severity of the disease and reasons for treatment are not just what you can see.”
Considering the mental health implications of skin disorders, Dr. Joseph weighs in on the options available for dermatologists and their patients in this area. For example, once a mental health issue is established, what are the next steps? She states that while in some practices, there are systems in place for referrals, this is not necessarily the case for dermatologists.