The Role of Exercise in Atopic Dermatitis, Spontaneous Urticaria

While engaging in physical activity can improve mental health symptoms, researchers said it can also exacerbate certain skin conditions, such as atopic dermatitis and chronic spontaneous urticaria (CSU).

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In a study,¹ researchers examined prior research related to a correlation between the 2, including existing literature on the anti-inflammatory effects of exercise and reduced inflammation and dermatitis symptoms in exercising mice. Using this existing knowledge coupled with the knowledge that physical activity and exertion can lead to exacerbated atopic dermatitis and lead to itchy hives in patience with CSU, researchers sought to further examine the correlation.

Furthermore, they sought to analyze exercise patterns among patients with atopic dermatitis and CSU, citing limited existing research on the subject.

In the cross-sectional study, researchers developed a questionnaire based off of patient-reported outcome measures.

135 patients with atopic dermatitis and 131 patients with CSU were enrolled in the study from outpatient clinics and private dermatology clinics in Aarhus, Denmark. Participants were required to be at least 18 years of age and meet the diagnostic criteria of either condition.

Researchers collected several pieces of information, including demographic data, skin disease onset and treatment data, and exercise habits or observations. This included asking participants to describe whether their personal condition was affected by exercise.

They also utilized several scales and indexes, including:

• Dermatology Life Quality Index (DLQI)
• Eczema Severity and Area Index (EASI)
• Generalized Anxiety Disorder (GAD-7)
• Insomnia Severity Index (ISI)
• Patient Health Questionnaire (PHQ-9)
• Patient-Oriented Eczema Measure (POEM)
• Physical Activity Scale 2 (PAS 2)
• Urticaria Activity Score (UAS)
• Urticaria Control Test (UCT)
• Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH)

Of the 135 participants with atopic dermatitis included in the study, 104 reported regular exercise habits. Of these, 62% reported receiving biological treatments, and 81% reported experiencing exacerbation of their condition due to exercise. These numbers were significantly lower in those with atopic dermatitis who did not exercise regularly.

Compared to their non-exercising counterparts, participants with atopic dermatitis who engaged in regular exercise reported lower symptom rates of depression, anxiety, insomnia, activity impairment, and disease severity. However, their average DLQI and EASI scores were higher than those who did not exercise.

Additionally, when exacerbation of their disease through sweat and exercise was taken into account, patients with atopic dermatitis reported higher DLQI and POEM scores, as well as higher work impairment and symptoms of depression, anxiety, and insomnia.

Of the 131 participants with CSU included in the study, 97 reported regular exercise habits. Of these, 52% reported receiving biological treatments, and 70% reported experiencing cholinergic urticaria, or itchy hives brought on by exertion.

Compared to their non-exercising counterparts, participants with CSU who engaged in regular exercise reported lower symptom rates of depression, insomnia, and work impairment. They also reported a lower average UCT disease control score. However, their average DLQI, activity impairment, and UAS7 disease severity scores were higher than those who did not exercise.

Additionally, when exacerbation of their disease through sweat and exercise was taken into account, patients with CSU reported higher DLQI scores, work impairment, activity impairment, and UCT and UAS7 disease severity scores, as well as symptoms of depression, anxiety, and insomnia.

“We found that exercising AD [atopic dermatitis] patients had significantly fewer symptoms of depression and anxiety and significantly less insomnia, though their disease severity did not differ from that of the non-exercising AD patients,” study authors wrote. “A large proportion of patients experienced exacerbation of AD in relation to exercising and sweating. Yet, this did not affect disease severity, QoL [quality of life], or mental health.”

Researchers also noted that patients with atopic dermatitis typically exert less physical activity than the general population.

Potential study limitations, as noted by the authors, included participants having potentially received effective atopic dermatitis treatment in the hospital and clinical settings they were recruited from, questionnaire length, and a lack of clarity in the causality between exercise and other parameters.

“It seems as if CSU patients, who are limited in their exertion of exercise, are additionally psychologically oppressed by the lifestyle constraints of their disease,” study authors wrote. “The benefits of exercise may be unobtainable due to the nature of CSU.”

Reference

1. Wiis MA, Heilskov S, Sørensen JA, et al. Physical activity and mental health among patients with atopic dermatitis or chronic spontaneous urticaria: A cross‐sectional study. JEADV Clinical Practice. 2023. doi:10.1002/jvc2.140