Managing Mental Health Comorbidities in Adult Patients With Atopic Dermatitis

Amidst the physical discomfort and challenges associated with managing atopic dermatitis (AD), patients often grapple with mental health comorbidities, further exacerbating their burden.¹ Despite its prevalence, the management of mental health issues in adult AD patients has not been extensively studied. To bridge this gap, a team of researchers from the US and Canada conducted an integrative review to explore guideline-based mental health recommendations and empirical evidence for interventions, engaging diverse stakeholders from the AD community.²

While modest evidence supports the efficacy of behavioral interventions such as mindfulness-based CBT, further research is warranted to enhance the quality of care provided to this vulnerable patient population. (Khunatorn/Adobe Stock)

Their study, presented as a poster at the 2024 American Academy of Dermatology Meeting in San Diego, California, involved a systematic search and quality assessment of clinical practice guidelines (CPGs) and decision aids spanning the post-dupilumab era between 2017, when the FDA first approved the drug, and 2022.

Methods

“Two reviewers independently screened full text and extracted management pertaining to mental health,” study authors wrote.“Descriptive analysis was compared with strength of evidence for psychological interventions in the treatment of adults. Patient-reported outcome measures (PROM)s were analyzed for mental health items.”Among 19 identified publications, a mere 26% met the Appraisal of Guidelines for Research & Evaluation II (AGREE-II) thresholds for recommended use without modifications.The majority of these guidelines (80%) suggested screening and external referral for AD patients with mental health co-morbidities, albeit without specifying the tools or types of external consultants.

Results

“PROMS included limited screening items. A minority (20%) recommended behavioral interventions or relaxation techniques, while current best evidence supports specific types of mindfulness-based cognitive behavior psychotherapeutic interventions with affected moderate to severe adult AD patients,” researchers wrote.

Contrary to the prevailing recommendations, empirical evidence points towards the efficacy of mindfulness-based cognitive behavioral psychotherapeutic interventions for adult AD patients with moderate to severe disease. However, the analysis revealed that only a minority of recommended CPGs (20%) included such behavioral interventions or relaxation techniques. This discrepancy underscores the existing gaps in managing mental health comorbidities within the AD patient population, as perceived by dermatologists adhering to established guidelines.

The study’s findings underscore the pressing need for a more comprehensive and evidence-based approach to addressing mental health issues in adult AD patients. While the current landscape of clinical practice guidelines provides a foundation, investigators shared that it falls short of adequately addressing the nuanced needs of this patient population. Moreover, the discrepancy between guideline recommendations and empirical evidence underscores the importance of ongoing research and evaluation to inform best practices in AD management.

Looking Ahead

“Gaps persist in managing mental health comorbidities with AD patients, as provided by dermatologists adhering to guidelines. Currently, modest evidence supports behavioral approaches such as mindfulness-based cognitive behavioral therapy (CBT), and large dedicated studies are needed to support future guidelines,” study authors wrote in their conclusion.

Moving forward, the poster’s researchers reported it is imperative to prioritize large-scale dedicated studies that explore the efficacy of psychological interventions tailored specifically for adult AD patients. By integrating empirical evidence with clinical expertise and patient preferences, dermatologists can adopt a more holistic approach to patient care, effectively addressing both the physical and psychological aspects of AD.

This study highlights the persisting gaps in managing mental health comorbidities in adult patients with AD within the framework of existing clinical practice guidelines. While modest evidence supports the efficacy of behavioral interventions such as mindfulness-based CBT, further research is warranted to enhance the quality of care provided to this vulnerable patient population.

Conflict of Interest Disclosure: The MUHC Centre of Excellence for Atopic DermatitisAD in Canada received unrestricted education grants from Sanofi, Abbvie, and Incyte. A rapid evidence review of psychological interventions performed by a psychology team was supported by a grant from Pfizer, "Wellness Together at MUHC Center of Excellence." No other authors received financial support for the research, authorship, or publication of this research. 

References

1. Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017. Br J Dermatol. 2021 Feb;184(2):304-309. doi: 10.1111/bjd.19580. Epub 2020 Nov 29. PMID: 33006135.
2. Ridha Z, Mija LA, Ghazal S, et al. Guideline-based interventions for managing mental health co-morbidities in adult patients with atopic dermatitis. Poster presented: 2024 American Academy of Dermatology Annual Meeting; March 8-12, 2024; San Diego, CA