Health Conditions Related to Eczema

Eczema is the name for a group of inflammatory skin conditions that cause skin to become dry and itchy. There are seven types of eczema. The most common type of eczema is atopic dermatitis. People with eczema are prone to also having other health conditions. When two or more chronic diseases present at the same time, it’s called a related condition or comorbidity. People with eczema, in particular atopic dermatitis, have several known comorbidities.

Comorbidities can worsen overall health, complicate disease management and increase health care expenses.¹ It is important to understand comorbidities and consider their effects on treatment and management of eczema. Learn about eczema-related conditions below.

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Atopic dermatitis, the most common type of eczema, has several known related conditions. The most prevalent comorbidity for atopic dermatitis is a set of allergic diseases known as the “atopic march.” The atopic march refers to three diseases: asthma, allergic rhinitis and food allergies.²

Doctors call it an atopic march because the conditions typically come on in a sequence one after another usually after being diagnosed with atopic dermatitis.² It can also start with asthma, and then progress to atopic dermatitis, allergic rhinitis, etc. The sequential order can vary in timing, age of onset and risk depending on the severity of atopic dermatitis.² In general, if a person has one of these four conditions — atopic dermatitis, asthma, allergic rhinitis or food allergies — the likelihood of developing one of the other three allergic conditions increases.

For example, 1 in 3 children with atopic dermatitis will also develop asthma or allergic rhinitis.³ In addition, the risk of developing asthma increases with the severity level of atopic dermatitis in kids. Specifically, more than 50% of children with severe atopic dermatitis also develop asthma.³

Asthma

About 25% of people with atopic dermatitis also have asthma, an allergic condition which causes a person’s airways to become inflamed, swollen and narrow.^2,4 This narrowing makes it difficult to breathe, leading to tightness in the chest, coughing and wheezing.² Asthma commonly first appears in childhood and can continue throughout a person’s lifetime.² Some people with asthma only experience it from time to time, while others need ongoing treatment in order to keep it under control.² Nearly 1 in 12 people in the United States have asthma, and it more often affects people with low-income, older adults, and Black, Hispanic and American Indian/Alaska Native people.⁵

Allergic rhinitis (hay fever)

Allergic rhinitis (or hay fever) is inflammation in the nose and sinuses caused by allergens like mold, pollen, dust mites, cockroaches and pet dander. Around 40.5% of people with atopic dermatitis also have allergic rhinitis and it affects 25% of children and 40% of adults globally.^6,7 The rates of allergic rhinitis are increasing, which is thought to be driven by increased urbanization and environmental pollutants that contribute to development of the condition.⁷

Symptoms of allergic rhinitis can include:

• An itchy nose, mouth, eyes or skin⁷
• A runny or stuffy nose⁷
• Sneezing⁷
• Watery eyes⁷
• Sore throat⁷

Food allergies

Children with atopic dermatitis are six times more likely to develop a food allergy than those without atopic dermatitis.⁸ The most common food allergies are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans.⁹

Symptoms of food allergies typically appear within 30 minutes of eating or breathing in a food allergen and can include:

• Itchy mouth and swelling of the lips⁹
• Vomiting, diarrhea, painful stomach cramps⁹
• Hives, rash or reddening of the skin⁹
• Blood pressure drop⁹

Recent studies have found that controlling atopic dermatitis through enhanced treatment with steroid creams can help reduce the onset of certain food allergies in infants, indicating that proper treatment of atopic dermatitis can reduce the likelihood of developing food allergies.¹⁰

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Contact dermatitis is another type of eczema. It is a chronic skin condition caused by an inflammatory reaction to contact allergens and irritants.¹¹ If you have atopic dermatitis, you’re more likely to also have contact dermatitis.¹²

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If you have atopic dermatitis, you might also be more at risk for developing an ear infection or urinary tract infection.¹³

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Due to problems with the skin barrier and an increase of bacteria on the skin, people with eczema are prone to skin infections from both bacteria and viruses, and your risk varies depending on what type of eczema you have.¹²

Staph infection

Scratching an itchy patch of eczema (whether its atopic dermatitis, contact dermatitis or neurodermatitis) can often open the skin and lead to infections. Symptoms of a skin infection include swollen and painful skin; skin that is warm/hot to the touch; pus-filled bumps (pustules); redness of the skin; and cold sores or fever blisters. Consult with a healthcare provider if you suspect you or your child have a skin infection.

People with atopic dermatitis are more likely than the general population to have “colonized” Staphylococcus aureus (staph) bacteria. This often increases the risk of staph infections.¹²

Eczema herpeticum

Eczema herpeticum is a type of infection caused by herpes simplex virus.¹⁴ It also causes cold sores, chickenpox and shingles.¹⁴ It primarily affects people with atopic dermatitis and other inflammatory skin diseases, and it has been found to affect less than 3% of people with atopic dermatitis.¹⁴ Eczema herpeticum can be very serious, especially when it spreads over wide areas of skin.¹⁴ It commonly appears as small, painful, fluid-filled blisters that appear on a patch of atopic dermatitis on the face, neck and upper trunk.¹⁴

Furuncles

Furuncles, also known as boils, start in the hair follicle and are caused by bacteria. Furuncles are usually discolored, warm and tender to the touch. They might look like a big yellow pimple but are usually deeper and hurt more than a pimple.¹⁵ They can go away on their own but often need medical treatment including removal procedures and topical or oral antibiotics.¹⁵

Impetigo

Impetigo is a common and highly contagious kind of bacterial (staph) infection.¹⁵ It can occur in eczema-affected skin that’s open and oozes fluid. If you have impetigo, honey-colored crusts may form on the open areas of your skin and can become painful and red.¹⁶ Impetigo is easily treated, usually with antibiotics.¹⁶

Cellulitis

Cellulitis is a deep infection in the skin and is usually very painful and tender to the touch. It is usually caused by staph or strep bacteria. In addition to redness, other cellulitis symptoms include swollen skin that is warm or hot to the touch.¹⁷ In severe cases, people with cellulitis develop a fever and elevated white blood cell count and may need to be hospitalized.¹⁷ If you have atopic dermatitis, nummular eczema or seborrheic dermatitis, you might be more at risk for developing cellulitis.¹⁷

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What Did Your Mental Health Journey Look Like?

In this video, four young adults with eczema talk about how their mental health was impacted by their eczema. They share openly and honestly about their firsthand experience.

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Researchers have noted higher rates of depression in individuals with all types of eczema.¹⁸ While this risk factor has been documented, researchers are still determining exactly why people with eczema are more likely to develop depression. One hypothesis is that burdens caused by eczema such as itching, disrupted sleep and social isolation can increase the risk of developing depression.¹⁸ Researchers also think that disrupted inflammatory responses might increase the risk for both depression and eczema, suggesting a biological link between eczema and depression.¹⁸ New research is being conducted to determine the exact link between eczema and depression.

Symptoms of depression include:

• Feeling sad, empty and/or anxious
• Feeling hopeless
• Loss of interest in hobbies or other activities
• Decreased energy, feeling tired more often
• Difficulty concentrating
• Restlessness, unable to sit still
• Problems sleeping
• Weight change
• Thoughts of death or suicide

If you experience any symptoms of depression, speak with your doctor about treatment.

Find a healthcare provider who specializes in eczema near you

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Like depression, researchers have also found that people with various types of eczema have higher rates of anxiety.¹⁸ The exact link between eczema and anxiety is still being researched. One hypothesis is that both eczema and anxiety are related to altered reward pathways in the brain, but further research is needed to determine this link.¹⁸ This hypothesis is further supported by the fact that certain anti-anxiety medications can also improve eczema symptoms.¹⁸

Symptoms of anxiety include:

• Your worrying is uncontrollable and causes distress¹⁹
• Your worrying affects your daily life, including school, your job and your social life¹⁹
• You cannot let go of your worries¹⁹
• Feeling restless or on edge¹⁹
• Being irritable¹⁹
• Getting tired easily¹⁹
• Having difficulty concentrating or feeling your mind goes blank¹⁹
• Having difficulty getting to sleep or staying asleep¹⁹
• Having tense muscles¹⁹

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Talking About Anxiety with Your Dermatologist

Dr. Shawn Kwatra, dermatologist and director of John Hopkins Itch Center, talks with eczema patient Sarah Harris about what dermatologists can do when eczema patients are faced with anxiety and depression.

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Studies have found that children with eczema are two times more likely to also have symptoms of ADHD.²⁰ Symptoms of ADHD include:

• Difficulty staying focused, wandering off task
• Lack of organization skills
• Hyperactivity
• Making hasty decisions that could be harmful

Research is still being done to determine the exact link between ADHD and eczema, however, one hypothesis is that it might be related to changes in inflammation or the gut microbiome (bacteria in the gut).²⁰

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Researchers have found that people with atopic dermatitis are more likely to have conditions such as rheumatoid arthritis, which causes pain in the joints; alopecia areata, an autoimmune condition that leads to hair loss in patches or spots; vitiligo, a condition where your skin loses its color; celiac disease, a condition where you have an immune reaction to gluten; and chronic urticaria, more commonly known as hives.^{12, 21}

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Atopic dermatitis is associated with a higher risk for osteoporosis and broken bones (fractures).²¹ This is because chronic inflammation, like that seen in people with eczema, can also lead to abnormal bone metabolism and increased bone loss.²¹ Researchers currently hypothesize this link could be due to decreased vitamin D and/or chronic systemic inflammation that is seen in people with atopic dermatitis.²¹ It could also be caused by increased topical and occasionally systemic steroid usage for treatment of atopic dermatitis.²¹

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Research shows that adults with atopic dermatitis may possibly have a higher risk of developing heart disease, high blood pressure and stroke.^{12, 21} This might also be because of underlying inflammation seen in atopic dermatitis.²¹