Acta Dermato-Venereologica 99-7CompleteContent | Page 8

647 CLINICAL REPORT Adult Patients with Atopic Eczema have a High Burden of Psychiatric Disease: A Finnish Nationwide Registry Study Saana KAUPPI 1,2 , Jari JOKELAINEN 3,4 , Markku TIMONEN 4 , Kaisa TASANEN 1,2 and Laura HUILAJA 1,2 PEDEGO Research Unit, University of Oulu, 2 Department of Dermatology and Medical Research Center Oulu, 3 Unit of General Practice, Oulu University Hospital, and 4 Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland ¹ Atopic dermatitis is associated with several comorbidi- ties. Epidemiological studies on psychiatric comorbidi- ties in adult atopic dermatitis patients are sparse. We analyzed psychiatric comorbidities in a Finnish nation- wide adult atopic dermatitis cohort. The study included 57,690 adult patients with atopic dermatitis as cases and 40,363 individuals diagnosed with melanocytic naevi as controls. Data was obtained from the statutory Finnish Care Register for Health Care. The prevalence of preselected comorbidities between the atopic der- matitis and control groups was compared. Every psy- chiatric disorder studied was more common in patients with atopic dermatitis than in controls. At least one psychiatric diagnosis was found in 17.2% of the atopic dermatitis patients and 13.1% of controls. Psychiatric morbidity is significant in patients with atopic derma- titis and therefore assessing patients’ mental health status should be considered as part of standard care. Key words: atopic dermatitis; comorbidities; mental disorder. Accepted Mar 8, 2019; E-published Mar 8, 2019 Acta Derm Venereol 2019; 99: 647–651. Corr: Laura Huilaja, Department of Dermatology, Medical Research Cen- ter Oulu, University of Oulu, Aapistie 5A, FIN-90220 Oulu, Finland; E- mail: [email protected] A topic dermatitis (AD) is the most common inflam- matory skin disease (1). Most previous studies on psychiatric comorbidities focused on attention-deficit hyperactivity disorders in children with AD (2). Only recent studies take into account the possible association of AD with different psychiatric diseases in adults (3–8). Register studies from Taiwan and the United States (5, 7) have reported an association between both anxiety SIGNIFICANCE Atopic dermatitis is associated with several comorbidities. In this study we investigated psychiatric comorbidities of adult patients with atopic dermatitis. Our study shows that at least one psychiatric diagnosis was found in 17.2% of the atopic dermatitis patients. Actually, every mental di- agnosis studied was more common in patients with atopic dermatitis compared to the melanocytic naevi controls. We report, for the first time, that atopic dermatitis is associa- ted with both schizophrenia and bipolar disorders. Since psychiatric morbidity is significant in patients with atopic dermatitis, assessing patients’ mental health status should be considered as part of standard care. and depression and AD in adults. In addition, a South Korean study found an increased risk for anxiety in AD patients (6). In contrast, a recent Danish study found no heightened risk for either anxiety or depression in pa- tients with AD, although an increased use of anxiolytic or anti-depressive medication was found (8). Only one previous study has reported the associations between AD and psychiatric comorbidities other than depression or anxiety in adolescent and adult patients with AD. AD was found to be associated with affective, stress-related, behavioural disorders and psychoses (9). Epidemiological data on AD are largely based on self-reported questionnaire studies (Tables I and II) (3, 10, 11, 14–17, 19) and previous results concerning the association of anxiety and depression with AD are inconsistent (5–8). To clarify the associations between AD and its psychiatric comorbidities at a national level, we conducted a retrospective study using the Finnish Care Register for Health Care (CRHC). Table I. Register studies about atopic dermatitis and its psychiatric comorbidities in the adult population First author, year n Study design (Country) Schmitt, 2009 (9) 3,769 Cheng, 2015 (5) 6,640 Kim, 2015 (12) Shin, 2016 (6) 1,517 25,419 Shrestha, 2017 (7) 119,716 Egeberg, 2017 (13) Thyssen, 2018 (8) 7,937 10,038 Comorbidity Data source A regional register study (Germany) Affective; neurotic, stress-related, somatoform; personality and behaviour; schizophrenic disorders A nationwide longitudinal register study (Taiwan) Major depressive disorder, anxiety disorders A cross-sectional register study (South Korea) Depression, anxiety, somatization A nationwide cohort study (South Korea) Psychiatric disorders A register study from 3 databases (USA) Anxiety, depression, sleep disorders A nationwide register study (Denmark) A register study (Denmark) Depression, anxiety Depression, anxiety This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. GKV database Saxony, interdisciplinary administrative outpatient database from Germany Taiwan National Health Insurance Research Database Regional Conscription Register Korea National Health Insurance Cohort Data Commercial, Medicare and Medi- Cal databases Danish National Patient Register Danish National Patient Register doi: 10.2340/00015555-3165 Acta Derm Venereol 2019; 99: 647–651