Itching can significantly disrupt sleep and negatively impact the mental health of individuals with atopic dermatitis (eczema). Those who suffer from this condition face a higher likelihood of developing mental health issues such as depression and anxiety. However, recent studies reveal that mental health concerns often go unaddressed during medical appointments for eczema.
Key findings include:
- Atopic dermatitis has been found to increase the risk of mental health conditions like depression and anxiety.
- Many patients with this skin condition report that their healthcare providers have not inquired about their mental well-being or referred them to mental health support services.
- More research is needed to determine which mental health resources are most beneficial for those living with atopic dermatitis.
Atopic Dermatitis and Mental Health: A Call for Holistic Care
Atopic dermatitis, commonly referred to as eczema, is a chronic skin condition that not only causes physical discomfort but also contributes to mental health issues like depression and anxiety. The itching, rashes, and flare-ups associated with this condition can cause significant emotional stress, affecting a person’s quality of life. Feelings of shame, embarrassment, and sleep disturbances brought on by incessant itching are just some of the factors that contribute to the mental toll of eczema.
Despite the well-documented link between eczema and mental health, many patients do not receive adequate mental health support. A recent study conducted by the National Eczema Association (NEA) highlights this gap in care, showing that a large number of patients and caregivers have never had mental health discussions with their healthcare providers. This oversight points to a significant unmet need in the holistic management of atopic dermatitis.
The Link Between Atopic Dermatitis and Mental Health
The NEA’s study, published in Skin Health and Disease on June 27, provides insight into the intersection of atopic dermatitis and mental health. The study surveyed nearly 1,000 participants, including both patients and caregivers of children and teens with eczema. Findings revealed that 42 percent of patients and caregivers had never spoken to their healthcare provider about mental health concerns related to eczema. Additionally, 50 percent of patients reported that their care provider had never initiated a conversation about their mental well-being.
The psychological burden of atopic dermatitis is immense. According to Wendy Smith Begolka, the senior author of the study and Chief Strategy Officer at the National Eczema Association, “Our data really does indicate that many individuals — even with milder disease, or even clearer skin — are dealing with mental health issues.” She emphasized that there is an opportunity to approach eczema treatment more holistically, addressing both skin symptoms and mental health challenges.
This research builds on previous findings from the NEA, which showed that 70 percent of individuals with eczema felt that their condition negatively impacted their mental health. A quarter of these individuals reported experiencing worsened mental health for at least 10 days each month, especially during flare-ups. These statistics underscore the strong connection between eczema symptoms and psychological distress.
A Vicious Cycle: Eczema and Mental Health
The relationship between atopic dermatitis and mental health can create a vicious cycle. Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University, notes that many patients become anxious about whether their treatment is working or about the possibility of future flare-ups. This stress, in turn, can worsen eczema symptoms, as psychological stress is known to increase inflammation in the body. “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,” explains Dr. Lio. “And when you’re feeling stressed and anxious, that’s been shown to further increase inflammation and worsen the skin.”
This cyclical relationship between mental health and eczema highlights the need for mental health support to be integrated into standard eczema treatment. Addressing only the physical symptoms without considering the emotional impact leaves many patients struggling with unspoken burdens.
When to Seek Mental Health Support
Currently, mental health support is not typically part of the standard treatment plan for eczema, which primarily focuses on managing skin symptoms through topical ointments, systemic drugs, and lifestyle changes. However, experts like Dr. Lio believe that mental health should be a central part of eczema care.
Individuals with eczema should consider seeking mental health support if they experience symptoms of depression or anxiety for more than two weeks. Common signs include feeling sad or hopeless, losing interest in usual activities, experiencing sleep disturbances, or having difficulty concentrating. Persistent tiredness, restlessness, or thoughts of death or suicide are also clear indicators that mental health care is needed.
Wendy Smith Begolka urges both healthcare providers and patients to initiate conversations about mental health. “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. Encouraging patients to discuss their emotional well-being with their care providers can open the door to more comprehensive treatment.
Available Mental Health Resources for Eczema Patients
The NEA study found that while many patients had not been referred to mental health resources, some had been directed to services like counseling, cognitive behavioral therapy (CBT), or peer support groups. Counseling was the most common referral, with 23 percent of patients accessing this resource. Thirteen percent were referred to CBT, and 12 percent were introduced to peer and social support networks.
“Never feel like you have to go at this alone,” says Begolka. She emphasizes that the NEA and other organizations offer numerous resources to help patients manage both the physical and mental health challenges of atopic dermatitis. For those seeking mental health support, she recommends the following resources:
- The American Psychological Association’s Psychologist Locator
- The American Psychiatric Association’s Psychiatrist Locator
- The National Alliance on Mental Illness (NAMI) HelpLine, which offers support through calls, texts, and emails
- NAMI’s support groups for individuals dealing with depression, anxiety, or other mental health conditions
Barriers to Mental Health Care for Eczema Patients
While mental health resources are available, access remains a challenge for many patients. Dr. Lio notes that proximity to mental health services, insurance coverage, and long wait times are common barriers. Additionally, some dermatologists may feel hesitant to initiate mental health conversations, as they may view it as outside the scope of their expertise.
However, Lio and Begolka agree that it is crucial for dermatologists and other healthcare providers to start normalizing these discussions. Dermatologists can play a pivotal role in helping patients access mental health support by providing referrals and fostering an open dialogue about the emotional impact of eczema.
Moving Toward a Holistic Approach
The NEA’s latest research represents an important step toward integrating mental health care into eczema treatment. The findings highlight the need for a more standardized approach to mental health discussions across all levels of atopic dermatitis care. “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,” says Begolka.
By recognizing the mental health challenges that accompany atopic dermatitis and providing resources to address these issues, healthcare providers can help patients break the cycle of stress and flare-ups. With a holistic approach that addresses both physical and emotional well-being, individuals with eczema can improve their quality of life and gain greater control over their condition.
In the meantime, continued research is needed to identify the most effective mental health interventions for eczema patients and to address the current barriers that prevent many from receiving the care they need. For now, one thing is clear: mental health must become a priority in the comprehensive treatment of atopic dermatitis.
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