Skill Checkup: A 32-Year-Old Man With a History of Atopic Dermatitis Presents With Worsening Itch

Diamant Thaçi, MD, PhD; Alan Irvine, MD, DSc

Disclosures

July 13, 2023

Inflammatory skin diseases such as AD may be potentially modifiable cardiovascular risk factors. Systemic inflammation has been recognised as a risk factor for cardiovascular disease. Dermatologic manifestations such as AD may help to identify patients at higher risk for cardiovascular disease.

Whether AD confers an increased risk for skin cancers has been controversial. In a 2022 study by Zhu and colleagues, AD was significantly associated with an increased risk for overall skin cancer, basal cell carcinoma and squamous cell carcinoma, but not melanoma.

Epidemiologic studies have consistently shown an association between AD and alopecia areata. Additionally, AD may be a marker of worse prognosis for alopecia areata with respect to severity and treatment response, though studies on this are limited.

AD has been associated with an increased risk of developing osteoporosis and a modestly increased risk for fracture. Reasons for this may include aberrant bone metabolism and increased bone loss, which can result from chronic systemic inflammation. Additionally, patients with AD are more likely to be deficient in vitamin D than those without AD, and sleep disturbances, which are common in AD, may increase the risk for traumatic injury in general. Finally, oral corticosteroids, such as those used to treat severe AD flares, are a risk factor for fractures. A 2021 study from Denmark found high cumulative use of potent or very potent topical corticosteroids may also confer increased fracture risk.

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