Mental health comorbidity in patients with atopic dermatitis.
School of Medicine, Oregon Health and Science University, Portland, Ore.
Recent data, primarily from Europe, suggest that children with atopic dermatitis (AD) might be at increased risk of mental health disorders.
We aimed to quantify the mental health burden associated with pediatric AD in the United States.
A cross-sectional study design was used analyzing data from the 2007 National Survey of Children’s Health, a survey reporting on the health status of 92,642 noninstitutionalized children aged 0 to 17 years.
The lifetime prevalence of various provider-diagnosed mental health conditions was calculated for those with and without a history of AD.
The odds of having attention deficit hyperactivity disorder was significantly increased in children with AD compared with the odds in control subjects without AD (odds ratio, 1.87; 95% CI, 1.54-2.27), even after controlling for known confounders.
The adjusted odds ratios for depression, anxiety, conduct disorder, and autism were
1.81 (95% CI, 1.33-2.46) (Depression)
1.77 (95% CI, 1.36-2.29) (Anxiety)
1.87 (95% CI, 1.46-2.39) (Conduct Disorder)
3.04 (95% CI, 2.13-4.34) (Autism)
respectively, and these estimates were all statistically significant.
A clear dose-dependent relationship was observed between the prevalence of a mental health disorder and the reported severity of the skin disease.
Our data reveal a striking association between mental health disorders and AD in the US pediatric population.The severity of the skin disease alters the strength of the association.
Prospective cohort studies are needed to verify these associations and to explore underlying mechanisms. Strategies to prevent AD or to aggressively treat early skin inflammation might modify the risk of mental health disorders in at-risk children.
Further Readings of Interest
Researchers discover genetic basis for eczema, new avenue to therapies
Researchers at Oregon State University today announced the discovery of an underlying genetic cause of atopic dermatitis, a type of eczema most common in infancy that also affects millions of adults around the world with dry, itchy and inflamed skin lesions.
The findings were just published in PLoS ONE, a professional journal, and may set the stage for new therapeutic approaches to this frustrating syndrome, which is difficult to treat and has no known cure. Eczema is also related to, and can sometimes cause asthma, a potentially deadly immune dysfunction.
Pharmaceutical scientists at OSU found in laboratory studies that eczema can be triggered by inadequate Ctip2, a protein and master regulator that affects other genetic functions. They have identified two ways in which improper function of Ctip2 can lead to eczema.
In a recent publication, they found that Ctip2 controls lipid biosynthesis in the skin, the fats that are needed to help keep skin healthy and hydrated. In the new study, they discovered that Ctip2 suppresses TSLP, a cytokine protein produced by skin cells that can trigger inflammation.
Levels of this inflammatory TSLP, which is ordinarily undetectable in human skin, were found to be 1,000 times higher in laboratory animals that had been genetically modified to have no Ctip2 production in their skin.
“In these studies, we’ve basically shown that inadequate Ctip2 is reducing the lipids in skin that it needs to stay healthy, protect itself and perform its function,” said Arup Indra, an associate professor in the OSU College of Pharmacy. “At the same time this can allow unwanted formation of proteins that trigger inflammation. The skin’s ability to resist inflammation is going down just as the amount of inflammation is going up, and the underlying reason is that Ctip2 is not doing its job.”
“Either or both of these problems can lead to eczema,” Indra said.
Atopic dermatitis is associated with a dysfunctional immune response, but researchers have never understood the underlying cause. Existing treatments use moisturizers to try to protect skin, and in difficult cases powerful steroid drugs can help, but they often have significant unwanted side effects, especially in long-term use.
“With a better understanding of just what is causing eczema on a genetic basis, we should be able to personalize treatments, determine exactly what each person needs, and develop new therapies,” Indra said. “This might be with topical compounds that increase Ctip2 expression in skin cells, or customized treatments to restore an individual person’s lipid profile. In the future, systemic epigenetic modification might even be possible.”
Functions of thymic stromal lymphopoietin in immunity and disease.
Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
Thymic stromal lymphopoietin (TSLP) is an interleukin 7-like cytokine expressed mainly by epithelial cells.
Current studies provide compelling evidence that TSLP is capable of activating dendritic cells to promote T helper (Th) 2 immune responses. TSLP has also been shown to directly promote Th2 differentiation of naïve CD4(+) T cell and activate natural killer T cells, basophils and other innate immune cells at the initial stage of inflammation.
In addition, TSLP affects B cell maturation and activation and can also influence regulatory T (Treg) cell differentiation and development.
TSLP-induced Th2 responses are associated with the pathogenesis of allergic inflammatory diseases, including atopic dermatitis, asthma, and rhinitis.
Based on recent findings in humans and mouse models, TSLP might also be involved in the pathogenesis of inflammatory bowel disease and progression of cancer. In this review, we will summarize our current understanding of the biology of TSLP and highlight the important issues for future investigations.
Autworks – http://autworks.hms.harvard.edu/