Association Between Atopic Dermatitis and Suicidality

Abstract

IMPORTANCE Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with numerous psychiatric comorbidities. However, the association between AD and suicidality has not been well established. OBJECTIVE To synthesize the available literature to evaluate the association between AD and suicidality. DATA SOURCE The protocol was prospectively registered in the PROSPERO database (CRD42018105291). STUDY SELECTION Per PRISMA guidelines, PubMed, Embase, PsycINFO, and Cochrane databases were systematically searched for relevant articles published from 1946 to May 25, 2018. The search criteria for PubMed were as follows: (dermatitis, atopic [MeSH] OR eczema [MeSH]) AND (suicidal ideation [MeSH] OR suicide, attempted [MeSH] OR suicide [MeSH] OR suicidality OR suicidal behavior). The search criteria for Embase, PsycINFO, and Cochrane were as follows: (atopic dermatitis OR eczema) AND (suicidal ideation OR suicide attempt OR suicide OR suicidality OR suicidal behavior). DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis performed in an academic medical setting included observational studies that evaluated suicidal ideation, suicide attempts, and completed suicide among patients with AD. MAIN OUTCOME AND MEASURE The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. RESULTS The analysis identified 15 studies with a total of 4 770 767 participants, of whom 310 681 were patients with AD (52.7% female) and 4 460 086 served as controls (50.9% female). In the meta-analyses, patients with AD were 44% more likely to exhibit suicidal ideation (pooled odds ratio, 1.44; 95% CI, 1.25-1.65) and 36% more likely to attempt suicide (pooled odds ratio, 1.36; 95% CI, 1.09-1.70) compared with patients without AD. Studies investigating completed suicides in patients with AD had inconsistent results. CONCLUSIONS AND RELEVANCE Results of this study suggest that patients with AD are at significantly increased risk of suicidal ideation and suicide attempts. It is important for dermatology providers to be aware of this risk, screen for suicidality in patients with AD, and make mental health referrals when necessary.

Anticorps monoclonaux thérapeutiques

“…Le dupilumab (Dupixent  ) est le premier AcM disponible dans la dermatite atopique modérée à sévère de l'adulte, en 2 e ligne après la ciclosporine. Il s'agit d'un anticorps humain de sous-classe IgG1 dirigé contre la sous-unité alpha du récepteur de l'IL-4, capable de bloquer les voies de signalisation dépendant de l'IL-4 et de l'IL-13 4 . Il s'administre par voie sous-cutanée à la posologie de 300 mg tous les 14 jours après une dose de charge de 600 mg.…”

“…3 La filaggrine est un acteur majeur de la différenciation terminale des kératinocytes et de la formation de la barrière cutanée. 4 prophylaxie à long terme des crises est proposée en cas de crises fréquentes (plus de 5 par an en France, Tableau III), mais l'utilisation au long cours des molécules disponibles est parfois problématique chez certains patients avec des antécédents thromboemboliques ou avec un capital veineux appauvri. Le lanadélumab, un AcM humain dirigé contre la kallikréine inhibe son action protéolytique sur le kininogène de haute masse moléculaire.…”

Validation of the Atopic Dermatitis Control Tool (ADCT©) using a longitudinal survey of biologic-treated patients with atopic dermatitis

“…To confirm known-groups validity, mean ADCT total scores were compared across adjacent subgroups of patients based on PGAD responses (Excellent, Very good, Good, Fair, Poor) and categories of DLQI responses: no effect on patient life (score range: 0-1), a small effect (2-5), a moderate effect (6-10), a very large effect (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), an extremely large effect (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) [36] ( Table 1). Patients in a worse PGAD or DLQI band subgroup were expected to display poorer AD control (i.e., higher mean ADCT total scores, indicating more severe symptoms/greater impact) than patients in a better PGAD or DLQI band subgroup.…”

Validation of the Atopic Dermatitis Control Tool (ADCT©) using a longitudinal survey of biologic-treated patients with atopic dermatitis

“…Atopic dermatitis (AD) is a systemic, inflammatory skin condition [1,2] characterized by intense pruritus, eczematous lesions, swelling, and pain [3][4][5][6]. With increasing awareness of the substantial patient burden associated with long-term uncontrolled AD [3,[7][8][9][10][11][12][13], especially as it relates to sleep disturbance, quality of life, and work or school performance [6,[14][15][16][17][18][19], assessment of patient selfreported disease control has been deemed crucial for clinical evaluation of AD [15,20,21].…”