Frequent Flares in Atopic Dermatitis Linked to Higher Anxiety and Depression, Study Finds
Denmark: A new study published in Acta Dermato-Venereologica reveals that adults with atopic dermatitis (AD) who experience frequent or unpredictable flares are more likely to face significant mental health challenges, including heightened levels of anxiety and depression. The research, led by Dr. Lea K. Nymand from the University of Copenhagen, emphasizes the psychological toll of unstable disease progression in individuals with AD.
Atopic dermatitis, a chronic inflammatory skin condition marked by episodes of flare-ups, affects millions globally. While much attention has been given to its physical manifestations, the impact of its fluctuating course on mental well-being is less frequently addressed. To bridge this gap, the research team conducted a longitudinal analysis involving 262 adult patients with dermatologist-confirmed AD diagnosed after the age of 18. The study tracked flare activity reported by patients between 2018 and 2023.
Using an unsupervised machine learning approach — specifically k-means clustering combined with dynamic time warping — the participants were grouped based on the frequency and stability of their flare patterns over time. Four distinct clusters emerged, each reflecting a different disease trajectory and corresponding mental health profile.
The study revealed the following findings:
- Patients in Cluster 1 had a milder disease course with fewer than six flares per year and reported the lowest median anxiety and depression scores of 3.0 and 1.0, respectively.
- Clusters 2 and 3 involved individuals experiencing 4 to 16 flares annually, with moderately higher anxiety scores of 6.0 and 4.0 and depression scores of 3.0 and 2.0, respectively.
- Cluster 4, marked by an unstable disease course with 14 or more flares per year, also showed elevated anxiety and depression levels, similar to Cluster 2.
- Instability in flare frequency, regardless of the number of flares, was found to have a significant impact on psychological well-being.
- A statistically significant difference in mental health outcomes was observed between patients with stable and unstable disease patterns, highlighting the importance of monitoring long-term disease activity.
These results point to the need for healthcare providers to look beyond momentary disease severity and incorporate flare history into treatment strategies. Addressing both the physical and psychological dimensions of AD, especially in those with fluctuating symptoms, may lead to better overall patient outcomes.
The authors concluded, "The study adds to growing evidence that managing atopic dermatitis effectively requires a holistic approach—one that not only targets skin inflammation but also considers the broader mental health implications of living with a chronic, unpredictable condition."
Reference:
Nymand, L. K., Nielsen, M.-L., Christensen , M. O., Thomsen, S. F., Thyssen, J. P., & Egeberg, A. (2025). Impact of Long-term Stability on Mental Health in Adults with Atopic Dermatitis: A Cohort Study with Unsupervised Cluster Analysis. Acta Dermato-Venereologica, 105, adv43071. https://doi.org/10.2340/actadv.v105.43071
