Atopic dermatitis and mental health: Is there a link?
- A review of evidence to date suggests that eczema is associated with a 63% increased risk of depression or anxiety.
- Possible explanations for the increased risks include social isolation and disrupted sleep as a result of itching.
- There may also be physiological links between the three conditions, via disruptions in hormones, the immune system, and nervous system.
- Treatments can help to alleviate both eczema and its associated mental health problems.
Eczema is an inflammatory skin condition that causes patches of dry, scaly, itchy skin that can crack. It is the most common form of atopic dermatitis.
According to the National Eczema Association, 31.6 million people in the United States have some form of eczema, which is about 10% of the population.
They note that the prevalence of atopic dermatitis among children in the U.S. has increased from 8% in 1997 to around 12%.
A review of the best available evidence has now found that eczema is associated with a 63% increased chance of developing either depression or anxiety.
When the researchers analyzed these two mental health conditions separately, they found that eczema was associated with a 64% increased risk of depression, and a 68% increased risk of anxiety.
To make their estimates, they pooled data from 20 studies that included a total of 141,910 people with eczema and 4,736,222 controls who did not have the condition.
The researchers, from the Sixth Affiliated Hospital of Kunming Medical University in Yuxi, Yunnan, China, have published their results in
The authors speculate that itching, disruptions to sleep, and social isolation may increase an individual’s’ risk of depression or anxiety.
“Social isolation and stigmatization can certainly occur as many patients experience their dermatitis on areas of their bodies that are public such as the face, neck, and hands,” said Beth Goldstein, a dermatologist at Central Dermatology Center, and co-founder of Get Mr., who was not involved in the new research.
“Intimate relationships can also be very difficult to navigate,” she told Medical News Today.
“It is extremely important to address the mental health component of eczema because the stress can cause flare-ups or worsen existing symptoms,” said Vivian Shi, MD, a dermatologist at the University of Arkansas for Medical Sciences in Little Rock, AR, who serves on the expert panel of the National Eczema Association.
“Treating the mental health component of eczema alongside the physical symptoms is crucial to maximize treatment benefits,” she added.
The authors of the new analysis emphasize that the physiological mechanisms that link eczema and mental health remain unclear.
But they note some interesting studies that suggest there may be shared physiological causes, such as oxidative stress and inflammation.
They also cite research in a mouse model of eczema, which found that the animals displayed anxiety and depression-like behaviors. The scientists behind this study showed that the behaviors were associated with changes in parts of their brains involved in processing reward.
Another study found that the antidepressant fluoxetine (Prozac) reduced symptoms of atopic dermatitis in mice and relieved their anxiety-like symptoms at the same time.
Fluoxetine appeared to suppress both psychological stress and inflammatory responses.
In humans, clinical trials demonstrated that a drug called dupilumab, which inhibits immune signaling molecules, not only improves eczema but also reduces anxiety or depression.
There may be a cycle of psychological stress, increased inflammation, and skin flare-ups in people with eczema.
The National Eczema Association says hormonal disruptions associated with atopic dermatitis can affect the nervous and immune systems, and skin cells themselves. This increases inflammation and disrupts the skin’s barrier function.
At the same time, psychological stress can inhibit skin repair.
The organization says people with atopic dermatitis, especially children and teenagers, can face stigmatization by their peers.
Stress and anxiety can boost the production of inflammatory molecules such as histamines, which in turn causes itching. Scratching may then damage the skin and exacerbate inflammation.
In a survey by the National Eczema Society in the United Kingdom, 74% of people reported that eczema had a negative impact on their mental health, and 66% said it led to feelings of loneliness and social isolation.
Fewer than half of these individuals said they had been offered professional psychological support to help manage these issues.
Children with eczema are particularly vulnerable to stigmatization, social isolation, and problems with self-esteem.
“It’s important that you talk to people about your skin if you are actually not feeling too great, if you are not in the best mood,” said Daniel, a teenager with eczema.
“It’s definitely important that you talk to people because they need to know that you’re not feeling great,” he said in a video about eczema and mental health from the National Health Service (NHS) in the U.K.
“If you surround yourself with positive people then you’re never going to hear a bad comment, you’re always going to have people looking out for you,” he said.
In addition to asking others for help, the National Eczema Association recommends keeping a journal and stress-relief techniques such as walking, mindfulness, and yoga.