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Increased risk of
cutaneous and systemic
infections in atopic
dermatitis
Journal of Investigative Dermatology
Take-home message
•
This large cohort study using The Health Improvement Network,
which is representative of the general UK population, revealed that
multiple cutaneous and noncutaneous infections are more common
in people with atopic dermatitis (AD) compared with those without.
In particular, people with AD had a 55% increased odds of impetigo,
27% increased odds of streptococcal throat infections, a threefold
increased odds of molluscum contagiosum, and a twofold increased
odds of otitis media.
•
Individuals with AD are likely to be at increased risk for both
cutaneous and noncutaneous infections, highlighting the need
for infectious screening and prevention programs aimed at this
patient population.
Abstract
Atopic dermatitis (AD, also known as atopic eczema or eczema), is characterized
by skin barrier and immunologic dysfunction. Viral and bacterial super-infection
of cutaneous lesions including eczema herpeticum and staphylococcus aureus in
patients with severe disease is well documented (Ong and Leung, 2016, Weidinger
and Novak, 2016). Whether the general population of patients with AD has an
increased risk of these and other types of infections due to an impaired skin bar-
rier and/or immunologic dysfunction is unclear.
Increased risk of cutaneous and systemic infections in atopic dermatitis –
A cohort study.
J Invest Dermatol
2017 Feb 12;[EPub Ahead of Print], SM Langan,
K Abuabara, SE Henrickson, et al.
Burden of skin disease report: implications
for dermatology
Journal of the American Academy of Dermatology
Take-home message
•
This commentary on the recent American Academy of Dermatology (AAD)
burden of skin disease report summarises the salient features of the study and
its implications for dermatologists. Importantly, the burden of skin disease study
revealed that skin disease is serious, highly prevalent, and potentially deadly.
Skin disease leads to a direct cost of US$11 billion in lost productivity, as well
as significant costs for over-the-counter skin treatment products purchased by
patients (US$10 billion).
•
Given the results of the updated report, the AAD is emphasising three key areas
that need attention. There is a need for research on additional prevention and
early detection strategies; research is needed into the role of dermatologists in
the treatment of skin disease; and data registries are important for future research
on outcomes.
Abstract
The most recent American Academy of Der-
matology burden of skin disease report builds
on the prior report in 2004 in providing strong
evidence of the serious nature of skin disease.
With nearly 85 million Americans treated for at
least 1 skin condition in 2013 at a direct cost of
$75 billion, and an additional indirect cost of
$11 billion, the findings of this study highlight
the impact of skin disease on patients and our
health care system and cannot be ignored.
Burden of skin disease report: implications for
dermatology.
J Am Acad Dermatol
2017 Mar
01;[EPub Ahead of Print], K Edison, B Brod.
COMMENT
By Mark A Bechtel
MD
T
his manuscript suggests a potential link between
immune dysfunction in atopic dermatitis and
increased susceptibility to cutaneous and non-cu-
taneous infections. It is becoming increasingly clear
from a research perspective that atopic dermatitis is
impacted by both skin barrier and immunologic dys-
function. The role of genetic abnormalities in filaggrin
and its impact on skin barrier function and atopic der-
matitis has been elucidated. Genetic abnormalities in
the regulation of the innate and adaptive immune sys-
tem and its role in increased risk of infection in atopic
dermatitis require further investigation.
Dermatologists are fully aware of the increased inci-
dence of molluscum contagiosum and Staph aureus
infections in our atopic patients. The increased inci-
dence of non-cutaneous infections, such as otitis media
and streptococcal pharyngitis in atopic patients may be
a surprise to many dermatologists. A greater insight into
the genetic abnormalities impacting immune dysfunc-
tion in atopic dermatitis is critical in determining which
patients are at greater risk of developing infections.
This will help in developing screening and prevention
strategies. Modification in our care and therapeutic
management could be necessary. Prevention strategies
to diminish the risk of cutaneous and non-cutaneous
infections will be important in the future
care of our atopic patients.
Dr Bechtel is Professor of Medicine
– Clinical and the Director of the
Division of Dermatology, Ohio State
University College of Medicine, Ohio.
EDITOR’S PICKS
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