Why Many With Atopic Dermatitis Don't Get the Mental Health Support They Need

Key Takeaways

• Atopic dermatitis is linked to an increased risk of depression, anxiety, and other mental health problems.
• Many with atopic dermatitis haven't been asked by their primary eczema care provider about their mental health or referred to mental health resources.
• Research hasn't yet shown what the best mental health resources are for people with atopic dermatitis.

Atopic dermatitis (eczema) comes with an increased risk of mental health issues like depression or anxiety . That can be due to feelings of shame or embarrassment about their condition or sleep problems caused by itch, for instance. But, many with atopic dermatitis don't receive the mental health support they need, according to a new study from the National Eczema Association (NEA).

The findings showed that 42 percent of patients with atopic dermatitis and caregivers of children and teens with the condition have never spoken to their eczema care providers about their mental health. Another 50 percent of patients have never been asked about their mental health by their care provider during any visits. The study, which included nearly 1,000 participants, was published on June 27 in the journal Skin Health and Disease .

Until now, there hasn't been a clear understanding of how much mental health support patients receive from their primary eczema care providers. The authors say this study is the first to open the conversation about what mental health resources people with eczema receive or don't receive. They're urging doctors, patients, and caregivers alike to talk about how the condition is affecting patients' lives.

"Our data really does indicate that many individuals - even with milder disease, or even clearer skin - are dealing with mental health issues," says senior study author Wendy Smith Begolka , who is the chief strategy officer at the National Eczema Association, where she oversees research, medical, and community affairs. "So there's certainly an opportunity to talk about mental health alongside treatment in a more holistic way, broader than what's just on the skin."

This latest study builds on earlier NEA findings that were published in March, which showed that about 70 percent of Americans with eczema felt their condition negatively affected their mental health, and 26 percent had worsened mental health for at least 10 days each month. It also showed that both adults and children with eczema had worsened mental health symptoms shortly before and during flares.

This link between eczema symptoms and worsened mental health can be a vicious cycle, says Peter Lio, MD , a clinical assistant professor of dermatology and pediatrics at Northwestern University in Chicago, who was not affiliated with the study. For instance, patients may worry whether their treatment is working, about a current or future flare-up, or about their ongoing symptoms - and stresses like these are known to exacerbate eczema, he says.

"There's a huge psychological component associated with atopic dermatitis and it really isn't addressed often," says Dr. Lio. "When your skin is causing you trouble, you're itchy, you're uncomfortable, you're ashamed of how you look and you're not sleeping well - that's going to make anybody feel pretty miserable. And when you're feeling stressed and anxious, that's been shown to further increase inflammation and worsen the skin."

How to Know if You Need Mental Health Support

Right now, mental health support isn't part of the standard treatment for eczema , which often includes options like topical ointments, systemic drugs, medications like antibiotics or antifungals, and self-care strategies like using a humidifier and avoiding tight or scratchy fabrics or lengthy showers in hot water.

But, it should be on the table, Lio says. If you or a loved one is experiencing some of these symptoms for two weeks or longer, you should see your healthcare provider:

• Feeling sad, empty, anxious, or hopeless
• Loss of interest or pleasure in activities you usually enjoy
• Frequent tiredness or lack of energy
• Problems with concentrating
• Restlessness, or an inability to sit still
• Sleep issues
• Weight changes
• Thoughts about death or suicide

These conversations could be as simple as doctors asking patients how they're faring, if they're sleeping well, or are under any distress, says Begolka. For patients, this may involve starting the conversation by telling their healthcare provider how they're feeling, she adds.

"Our [patient] community did feel they could tell the correlation between the increasing severity of their atopic dermatitis and their mental health. They have a strong sense of when something is off," she says. "If you're feeling it, try to have that strength and comfort to be able to raise that with your healthcare provider so they can work to address it in a variety of ways."

Mental Health Resources for People With Eczema

Sixty-four percent of adults and caregivers of young patients in the study weren't referred by their providers to mental health resources. But when patients were referred, the most common resources were counseling (23 percent), cognitive behavioral therapy (13 percent), and peer and social support groups (12 percent).

"Never feel like you have to go at this alone," says Begolka. "We recognize this is a disease that has a lot of nuance, it's a multidimensional burden, and we have a number of resources that can be helpful to support not only healthcare providers but patients throughout their journey."

If you'd like to seek mental health help, either through counseling given by a mental health professional or a support group, Begolka recommends the following resources:

• American Psychological Association's Psychologist Locator
• American Psychiatric Association's Psychiatrist Locator
• National Alliance on Mental Illness (NAMI) HelpLine (reachable by call, text, or email)
• NAMI support groups for people with depression , anxiety , or other mental health conditions

More research is still needed to pinpoint the most effective mental health interventions for people with eczema, to recognize the current barriers to referring patients to mental health care, and to better understand the role organizations like the NEA or NAMI have in helping to connect patients and doctors to resources, notes Begolka.

Lio adds that it can be tricky for dermatologists to open up the lines of communication for mental health help for their patients. While they can offer suggestions or make referrals, issues like proximity to counseling services, insurance policies, and wait times can get in the way, he says. Some dermatologists may feel out of place recommending mental health assistance to patients, too, he says.

But Lio and Begolka agree the new research is an important step in normalizing mental health discussions within the eczema community. "This is an opportunity for the conversation to occur in a much more standardized way across all atopic dermatitis care, regardless of what healthcare provider is being seen," Begolka says.

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Sources

1. Chatrath S et al. Evaluating Mental Health Support by Healthcare Providers for Patients With Atopic Dermatitis: A Cross-Sectional Survey. Skin Health and Disease . June 15, 2024.
2. New Research Finds Low Rates of Mental Health Support for Eczema Patients Despite Clear Correlation. National Eczema Association . June 27, 2024.
3. Johnson JK et al. Patient and Caregiver Perspectives on the Relationship Between Atopic Dermatitis Symptoms and Mental Health. Dermatitis . March 14, 2024.
4. Eczema and Emotional Wellness. National Eczema Association .