Atopic dermatitis: Clinical associations recommendations

  • Physicians should be aware of and assess for conditions associated with atopic dermatitis, such as rhinitis/rhinoconjunctivitis, asthma, food allergy, sleep disturbance, depression, and other neuropsychiatric conditions, and it is recommended that physicians discuss them with the patient as part of the treatment/management plan, when appropriate.  

Level of Evidence: I,II Strength of Recommendation: C

  • An integrated, multidisciplinary approach to care may be valuable and is suggested for atopic dermatitis patients who present with common associations.

Level of Evidence: III Strength of Recommendation: C

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Common associations/comorbidities of AD that have been supported by studies include other atopic conditions: namely, food allergies, asthma, and allergic rhinitis/rhinoconjunctivitis.77-84  Some consider AD to be the start of the “atopic march,” given the frequent subsequent development of one or more of the other atopic conditions. However, the association of other atopic conditions with AD is complex and multifactorial, as this progression does not happen in all individuals.  Patients living in humid climates or developing countries may manifest AD only after changing their locale and/or following onset of respiratory allergies.85-88   

Sleep disturbance is also common and stems in large part from the significant itch associated with AD.69,70,89,90 Sleep is disrupted in up to 60% of children with eczema, increasing to 83% during exacerbation.91 Along with the affected individual, other family members may also suffer as a result of being awakened.68 Even when in clinical remission, individuals with eczema demonstrate more sleep disturbance than do healthy individuals.91 Greater skin disease severity appears to have an effect on mood as well. Depression has been noted in both teens and adults affected with AD.92,93  More recently, there has been a suggested association of AD with behavior disorders, e.g. attention deficit hyperactivity disorder (ADHD), especially in children.94,95  However, association does not establish causality and the precise nature of the relationship requires further study, including the role of sleep disturbance and ADHD-like behaviors, as well as the possibility of non-specific linkage to any chronic disease of childhood.94

Navigate section 1 of the AD guideline: Diagnosis and assessment

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. 

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