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A Massive Study Has Exposed The Deadly, Hidden Burden Shouldered by Eczema Patients

PETER DOCKRILL
12 DEC 2018

People who experience the pain and disfigurement of eczema (aka atopic dermatitis, AD) already have to contend with cracked skin, rashes, weeping sores, and endless itching.

But that's not all. New research examining the "profound psychosocial burden" shouldered by people with AD shows they're not just at greater risk of depression; having the skin condition significantly elevates their chances of also having suicidal thoughts and attempting to take their own life.

 

To ascertain whatever links might exist between atopic dermatitis and suicidality, a team led by dermatologist April Armstrong at the University of Southern California sifted through 15 existing studies involving almost 5 million participants, including over 300,000 eczema patients.

Previously, scientists knew that people with eczema are more susceptible to developing depression and anxiety, but it wasn't clear how these psychological effects related to suicide – whether in ideation (suicidal thoughts), attempts made, or suicides completed.

Now, thanks to Armstrong's analysis, we've got a better picture of how AD and suicidality are linked – albeit a bleak one, sadly.

According to the results of the meta-analysis, AD patients across the studies were 44 percent more likely to exhibit suicidal ideation than people without the condition, and 36 percent more likely to attempt suicide.

The data on individuals who  took their own life was more limited and showed inconsistent results, so we can't draw firm conclusions on it.

Even without that, though, the figures on suicidal thoughts and attempts by themselves suggest a grim, pervasive phenomenon that scientists weren't aware of.

While the extent of the problem may be a shock, the fact the phenomenon is measurable like this is not a surprise, given the gamut of physical and psychosocial burdens AD can bring about in those with the condition.

 

"Patients with uncontrolled AD may experience debilitating symptoms of pruritus, burning, and pain of the skin. Furthermore, sleep loss caused by pruritus has been shown to increase risk of suicidality in patients with AD," the authors write in their paper.

"Psychosocial factors, such as the stigmatisation and shame experienced from their disease, and impairment of school or work performance may also contribute to the increased risk of suicidality seen in patients with AD."

Other research also suggests that molecules called proinflammatory cytokines in the central nervous system – which are associated with AD – could alter serotonin metabolism, and in doing so disrupt the operation of neurotransmitters in the brains of AD patients.

It's only hypothetical, but with further investigations down this track, Armstrong and team suggest we might be able to identify the "pathogenesis of suicidality" in AD patients, while other research looks into lessening the physiological causes of chronic inflammation, and the resulting effects it has on patients.

In the meantime, the researchers say these grave findings are something that needs to be taken on board by  dermatologists, who could implement suicidal screening into patient visits, or use questionnaires to gauge risk levels and look out for warning signs in patients who aren't feeling okay.

These kind of professional adaptations are "crucial to improving patient outcomes", the researchers write.

After all, it's not just their skin we want to save.

The findings are reported in JAMA Dermatology.

If this story has raised concerns or you need to talk to someone, here's a list where you may be able to find a crisis hotline in your country.