Acta Dermato-Venereologica 99-7CompleteContent | Page 9

652 CLINICAL REPORT Comorbidities Associated with Severity of Atopic Dermatitis in Young Adult Males: A National Cohort Study Wai Leong KOK 1,2# , Yik Weng YEW 1# and Tien Guan Steven THNG 1 National Skin Centre, Singapore, and 2 Headquarters Medical Corps, Singapore Armed Forces, Singapore These authors have contributed equally and should be considered as first authors. 1 # Atopic dermatitis (AD) is a systemic inflammatory dis­order. However, the relationship between seve- rity of AD and metabolic and atopic conditions is not well studied. The aim of this study was to elucidate the relationship between severity of AD and comorbi- dities, such as metabolic conditions (increased body mass index, hypertension, hyperlipidaemia, and type II diabetes mellitus) and other atopic manifestations (allergic rhinitis, asthma and food allergies). A retro- spective population-based national study of a cohort of young adult males conscripted into military service in Singapore over a 5-year period was performed, uti- lizing military electronic medical records. A dose-de- pendent effect was found between the association of comorbidities and severity of AD. Metabolic and atopic conditions were significantly correlated with having moderate-to-severe AD. An association of metabolic and atopic conditions with severity of adult AD was found, which suggests that chronic severe AD may re- sult in increased disease burden and morbidity. Key words: atopic dermatitis; eczema; co-morbidities; atopy; metabolic. Accepted Mar 21, 2019; E-published Mar 21, 2019 Acta Derm Venereol 2019; 99: 652–656. Corr: Yik Weng Yew, National Skin Centre, 1 Mandalay Rd, 308205 Singa- pore, Singapore. E-mail: [email protected] A topic dermatitis (AD) is a chronic relapsing inflam- matory skin disease with several reported disease associations (1), which affects up to 10% of adults (2). Comorbidities, such as metabolic conditions (increased body mass index (BMI), hypertension, hyperlipidaemia, diabetes mellitus) and atopic conditions (allergic rhinitis, asthma and food allergies) are reportedly associated with a higher risk of adult AD (3–7). AD has been described as a systemic inflammatory and allergic skin disease (1); hence the presence of metabolic comorbidities and atopic conditions in patients with AD is postulated to lead to a chronic inflammatory state, which perpetuates disease progression, leading to a more severe form of AD (8, 9). With a paucity of studies examining the link between comorbidities and the severity of AD in adults (10, 11), the aim of this study was to further investigate the postulated associations in the Singapore population. Singapore is an urbanized, multi-ethnic society with an increasing prevalence of AD, atopic and metabolic doi: 10.2340/00015555-3175 Acta Derm Venereol 2019; 99: 652–656 SIGNIFICANCE - Associations between metabolic and atopic diseases with atopic dermatitis severity are not well described. - Positive correlations were found between metabolic and atopic co-morbidites and an increasing severity of AD in our study. - Management of metabolic and atopic co-morbidities, is important in the holistic management of adult AD. conditions, similar to that in other developed countries (2, 12). Singapore also has a predominantly conscript army, which requires all eligible male adult citizens to undergo baseline medical health screening prior to enlistment for military service. Utilizing the data from this national military electronic medical record (EMR), this study examined, in a national cohort of young adult males, the hypothesis that metabolic and atopic comorbidities are associated with increased severity of AD. METHODS The study cohort consisted of all military conscripts with a diagno- sis of AD made during their military medical screening from 1 Jan 2010 to 31 Dec 2014. Subjects were identified from the Singapore Armed Forces EMR using validated Systematized Nomenclature of Medicine - Clinical Terms (SNOMET-CT) diagnosis codes (D0-10130, D0-10183-87). Diagnoses of hypertension, hyperli- pidaemia, type 2 diabetes mellitus, allergic rhinitis, asthma and food allergies were retrieved from the EMR using SNOMET-CT diagnoses codes. During their medical screening, all cases had their diagnosis codes documented in the military health records after assessment by military medical officers with verification from the relevant specialists. Information such as demographic data (age, ethnic groups), highest education level achieved (as a surrogate marker for socio- economic status) and anthropometric measurements, such as height, weight and BMI, were retrieved for analysis as covariates and potential confounders (Fig. 1). Severity of AD for each sub- ject was recorded in the EMR as mild, moderate or severe. This physician-based severity classification was global and based on the body surface area affected, frequency of disease flare, treatments required, and functional impact of those affected. It reflects how the disease was affecting the subject’s daily functional activities. For example, mild cases of AD had limited involvement, requiring only topical therapy with infrequent flares, while moderate AD has more frequent intermittent flares. Severe cases of AD were those with extensive involvement, requiring systemic immunosuppres- sants and/or significant impact to function. Odds ratio (OR), 95% confidence interval (CI), and p-values were calculated to test the null hypotheses of the association This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.