The ‘Invisible’ Burden of Atopic Dermatitis: Why Your Dermatologist Needs to Hear About Your Mental Health

"Atopic dermatitis is not just a skin condition, it is a chronic inflammatory disease that affects the nervous system and emotional well-being as well," says Mona Foad, MD, a dermatologist and the founder of MONA Dermatology in Cincinnati. "The skin and nervous system are closely connected, sharing many of the same inflammatory pathways. Ongoing skin inflammation can stimulate nerve endings, which places continuous stress on the body."

Here's a closer look at the connection between AD and mental health, plus tips for getting the support you need.

"This type of stress triggers the release of cortisol, the fight-or-flight hormone, which then increases systemic inflammation even more," she says. "This perpetuates a cycle of scratching and AD lesions."

Chronic stress also weakens your immune system, which causes flares to happen more frequently and makes symptoms more intense, says Elizabeth Geddes-Bruce, MD, a dermatologist at Westlake Dermatology in Austin, Texas.

"Patients often notice that their AD flares during stressful periods, and it's because of this complicated interaction between the immune system, the nervous system, and the skin," she says.

• Trouble concentrating
• Avoiding activities or social gatherings
• Irritability or sudden bursts of anger or sadness
• Feelings of worthlessness or low self-confidence
• Restlessness
• Reduced pleasure in hobbies
• Changes in appetite
• Feeling constantly drained or tired
• Significant weight fluctuations
• Physical symptoms like headaches and stomachaches

"You may not always connect issues like these to your atopic dermatitis, but they can definitely be related," says Dr. Foad.

Bringing up mental health in a dermatology appointment may feel overwhelming, embarrassing, or stigmatizing for some with AD, yet it's a crucial part of treatment, says Dr. Geddes-Bruce.

You shouldn’t look at mental health challenges as a failure of your ability to "tough it out" or to "look on the bright side," she says. It’s usually a sign your AD is not being controlled as well as it could be.

With that in mind, here are some things you can say to get the conversation going:

• I've noticed my mood is being more affected by my condition and I want to talk about that.
• Because of my flares, I've been avoiding social activities, and feel self-conscious even when I run errands, so I think it's time to address my emotional health.
• My symptoms are affecting my sleep quality and that's leading to more difficulty with my mental wellbeing. Let's talk about that next.
• The constant itching is causing more stress than I've felt in the past and that's affecting my work and home life. What are other treatment options that can help?
• I can tell that my mental health is not where it should be and I'd like to hear about some treatment changes that could be meaningful, as well as a referral to psychological resources.

It's often helpful to track symptoms over a period of time to identify any patterns and give your doctor data to work with, suggests Dr. Huang. For example, you might experience more sleep disruption when you use topical corticosteroids in the evening, then feel irritable or fatigued the next day. Or you could be more anxious if flares are happening more often, and that's raising your overall stress level.

This conversation is an important kickoff for getting what you need. For instance, you might have to pivot toward systemic therapies to address the underlying inflammation in AD.

"Treatment helps patients get their life back," says Geddes-Bruce. "Mental health challenges are absolutely a reason to escalate therapy. Improving quality of life is about more than just visibly clear skin."

• Mental health challenges are common with atopic dermatitis, yet nearly half of patients don't discuss these difficulties with their doctors.
• The emotional toll of atopic dermatitis isn't just psychological; there is a physiological process connecting the immune system, nervous system, and skin health.
• Mental health struggles could be a sign that you need to switch your atopic dermatitis treatment so it works more effectively for you.