Learn about comorbidities that are often seen in patients with atopic dermatitis (AD) and treatment strategies that can effectively address both AD and associated conditions. 

Transcript: 

Hello, and thank you for joining us today. My name is Dr Saakshi Khattri. I'm a board-certified dermatologist and rheumatologist at the Icahn School of Medicine at Mount Sinai in New York City.

In this video, we will talk about a few of the most common comorbidities associated with atopic dermatitis, and what healthcare providers can do to provide a more comprehensive treatment approach. Before we talk about the other associations, let's first just have a high-level overview of the pathogenesis of AD.

We have to understand that patients that have atopic dermatitis, it's not just a skin disease. These patients do have a higher risk of other allergic comorbidities, and certainly, some non-allergic comorbid conditions as well, and that adds another layer of complexity in managing patients with AD.

In terms of, you know, other allergic associations, which sort of span the TH2 immune pathway, we have allergic rhinitis, we have allergic conjunctivitis, asthma, seasonal allergies that can be seen. You all will be familiar with what is called the atopic march, which basically means that patients develop atopic dermatitis and then followed by serial incidents of food sensitivity, asthma, and hay fever. Patients that have atopic dermatitis also have a 3- to 4-fold increased risk or odds of having another atopic disease.

So, it's important to, well, talk to our patients about it or ask questions about the other atopic diseases that they may have associated with atopic dermatitis. You know, recent studies that attempted to establish or estimate the prevalence of these comorbidities found that patients with AD, about 41% of them had rhinitis, 26% of them had asthma, and 14% had both rhinitis and asthma. And when it comes to association with food sensitivities, you know, adults with atopic dermatitis, about 29% of them had food sensitivities and 24% of them had food allergies.

It is important to note that children with atopic dermatitis tend to have a higher percentage of both food sensitivity and food allergies. So once again, important to keep all of these extracutaneous manifestations in mind, you know, the whole atopic manifestation in mind. There are increasingly published data looking at other autoimmune diseases associated with atopic dermatitis.

There have been, you know, cross-sectional studies or population-based studies that have shown that patients that have atopic dermatitis can have vitiligo, chronic urticaria, celiac disease, inflammatory bowel disease, lupus, and rheumatoid arthritis. So, certainly, something to be kept in mind when you're seeing patients with atopic dermatitis. Now let's move on to talking about current treatment and management strategies for addressing multiple comorbidities in patients with AD.

Now we're in the midst of this treatment revolution with AD. We have a slew of systemic options that are out there to treat patients with atopic dermatitis, so it has definitely become easier to manage patients with AD compared to 10 years ago, when we didn't have targeted therapies.

But when we are selecting a treatment option for patients with AD, we need to take into account what other comorbid conditions they have and whether these therapies won't increase the risk or worsen what they have outside of AD. So, that is something that should be considered. And then, you know, cross-collaboration or collaboration amongst different specialties.

As mentioned previously, patients that have had AD tend to have a lot of allergies, you know. So, certainly, referring these patients to an allergist-immunologist is helpful, and for the dermatologist to partner with the allergist-immunologist in such a scenario is important to take care of a patient that not just has AD but might have other non-extracutaneous atopic manifestations, as mentioned previously.

And this is where, you know, the whole concept of multidisciplinary team approach has gained traction. There are institutions that have centers of excellence for AD where dermatologists cross-collaborate with immunologists and allergists when it comes to treating patients with AD.

Finally, how would you help your patients understand how their comorbid conditions are intertwined? So, this is where, you know, patient education is important. To tell a patient who's coming to see you with AD, you know, in the derm office, to tell them that, you know what, besides AD, you can have seasonal allergies, you can have allergic rhinitis, allergic conjunctivitis, you can have hay fever, food allergies, is important because this allows the patient to understand that, you know, AD, while it is a skin disease, you have other atopic associations that can be seen. And, certainly, in such a scenario, patients can be referred out sooner to an allergist-immunologist to, you know, detect whether they have these other disease associations as well is important.

Giving our patients the knowledge of other associations with AD is important because it empowers them to understand that while they are coming to see a dermatologist with AD, they could have other allergic manifestations or associations that need to be looked into as well.

I hope that this was helpful in shedding light on the complexity of AD and associated comorbid conditions. Thank you so much for listening.