The American Academy of Dermatology’s last guidelines to aid clinicians in the diagnosis, treatment, management, and care for atopic dermatitis in adult patients were released in 2014. Recent developments in this disease area, including newly approved therapeutics such as JAK inhibitors, and a better understanding of disease mechanisms such as systemic inflammation, necessitate a renewed look at the recommendations for how providers approach patient care for this chronic, relapsing, and often lifelong skin condition. Earlier this year, a committee tasked with reviewing all available literature, data, and study findings released the first of what is expected to be many revised guidelines for the management of atopic dermatitis.
AAD joint committee
A multidisciplinary joint workgroup appointed by the American Academy of Dermatology (AAD) – after conducting a thorough and systematic appraisal of available literature – released new guidelines on the observed links between atopic dermatitis (AD) and several conditions that are common comorbidities of AD in adult patients. The objective of these updated guidelines is to increase awareness and understanding among providers regarding possible conditions that can increase disease burden and worsen quality-of-life for patients with AD.
The resulting guidelines
The evidence examined resulted in 32 statements from the AAD’s committee of clinicians, researchers, and experts in the dermatology community. They reported significant associations between AD and some allergic, atopic, immune-mediated, mental-health, bone, and infectious skin disorders. The group also found moderate associations between AD and substance use, cardiometabolic, and behavioral disorders, and small associations between AD and cardiovascular disease. Notably, the committee made no recommendations for screening or management of comorbidities in adults with AD but support further investigation into this topic. The updated AD guidelines, released in early 2022, supersede those set by the AAD in 2014.
Key points from the committee’s 2022 recommendations include:
- Patient- and population-level disease burden of AD is increased by associated comorbidities.
- There is strong evidence that AD in adults is associated with select allergic, atopic, immune-mediated, mental health and bone health comorbidities, and skin infections.
- There is some evidence supporting an association between AD in adults and substance and tobacco use disorder, and adult attention-deficit/hyperactivity disorder
- Evidence suggests a small association between AD and various cardiovascular conditions
- There is an undetermined association between AD in adults and autism spectrum disorders, myocardial infarction, stroke, and metabolic syndrome
- The association between AD and asthma is well established, but the atopic march explanation (progression from AD to asthma observed in children) remains unproven
- There is clear evidence of an association between AD and food allergies, although estimated prevalence of food allergies in adults with AD is low
- Epidemiologic studies show an association between AD and alopecia areata
- Self-reported or clinician-observed depression occurs twice as often in individuals with AD
- Accumulating evidence suggests small associations between AD and hypertension, peripheral and coronary artery disease, congestive heart failure, and acute clinical events
- Evidence suggests a small association between adults with AD with and obesity and dyslipidemia
- Limited data point to a possible inverse association between AD and diabetes
- Several studies have shown associations with increased risk of osteoporosis and fracture in adults with AD, possibly linked by systemic inflammation
Dermatologists and other clinicians who care for patients with AD should be aware of several common associated comorbidities that may exacerbate the condition and negatively impact quality-of-life. Future studies may help determine whether screening for comorbid conditions should be recommended for adults with AD.