How Atopic Dermatitis Affects Mental Health

Living with atopic dermatitis “can genuinely feel uncomfortable to be in your own skin,” as described by Ethan Chee, a master of social work student at Columbia University.

Atopic dermatitis (AD), the most common form of eczema, is a chronic inflammatory skin condition that leads to irritation and redness. The National Eczema Association estimates that 16.5 million adults and roughly 9.6 million children in the U.S. live with AD. 

Researchers haven’t yet pinpointed a specific cause for AD, but they’ve determined that the immune system, environment, and genes play a part. Though AD typically manifests in childhood, adolescents and adults can develop it, too. Those living with this condition experience a lot of itchiness, which can then result in swelling, scaling, fluid release, and crusting. Symptoms can ebb and flow, with flares followed by periods of clearer skin, known as remission.

The physical aspect of AD can be tough on affected individuals’ mental health. Here are several ways challenges in social and emotional functioning can manifest. 

The Psychological Impact of Atopic Dermatitis

AD and stress can have a cyclical response, with one exacerbating the other, and vice versa. “Chronic stress makes AD symptoms worse by activating the stress response system, which in turn, leads to increased inflammation and flare-ups,” says Dr. Rostislav Ignatov, chief medical officer at The Haven Detox. 

AD can also have a pronounced impact on self-esteem and body image. Chee says “Having eczema has lowered my self-esteem. It makes me feel like there’s something wrong with my physical appearance, like a flaw.” As a kid, he was bullied for his eczema. Even though his symptoms are relatively under control now, he still tends to hyper-fixate on his physical appearance. 

Mental health discomfort is another outcome of AD. Dr. Arjun Dupati, a double board-certified dermatologist and Mohs surgeon at Apollo Dermatology weighs in: “In dermatology, we refer to a phenomenon known as the ‘itch-scratch cycle,’ he says. “Rashes that itch are further worsened by the act of scratching through the release of additional inflammation-inducing proteins.” This can result in frequent scratching and discomfort, which can negatively impact a person’s self-confidence. 

Visible symptoms can also impact social interactions, as is the case for Leonna, a full-time professional in her late 20s. For Leonna, having eczema has made her feel self-conscious when shaking people’s hands, or less confident when wearing clothes that expose affected areas. “It makes it hard for me to express myself,” she says. “With eczema being physical, I always think of covering it. It kind of translates to me covering part of my personality, as well.” 

Mental Health Conditions Associated With Atopic Dermatitis

Certain mental health conditions are more likely to co-occur with AD. Here are three commonly observed in those living with this skin condition. 

Depression

A 2020 study in the Journal of Allergy and Clinical Immunology: In Practice found that people living with AD are 14% more likely to develop depression than those without the condition. Many factors can contribute to this link, including chronic pain, social stigma, bullying, loneliness, and lack of sleep due to discomfort. 

Anxiety

The same study found that those living with AD are also 17% more likely to develop anxiety than those without the condition. For individuals living with AD, anxiety-induced symptoms can often manifest around stressful life events, such as moving, going through a breakup, or dealing with challenges at school or work. 

Sleep Disorders

A 2022 study found that AD is associated with sleep disturbances in 47-80% of children and 33-90% of adults. Typically, the more severe the physical symptoms, the greater the negative impact on sleep. These disturbances include difficulty falling asleep, frequent nighttime or early morning awakenings, trouble waking up, and daytime sleepiness.

Sleep deprivation is linked to many detrimental mental health outcomes. Those who have difficulty sleeping on a regular basis tend to struggle with irritability and poor stress resilience. Studies have also shown that sleep disturbances are linked to mental health conditions such as depression, anxiety, PTSD, and eating disorders.

AD’s Effect on Different Age Groups

Children and Adolescents

AD is associated with increased absenteeism from school. A 2021 study in the Journal of the American Academy of Dermatology found that among children living with the illness, 67.7% miss school more than one day a year because of the condition, while 3.9% missed more than 15 days.

For Leonna, living with AD while trying to get good grades and apply to colleges was an added challenge. “My skin freaking out meant another thing to stress about,” she says. She also mentions the physical impact of having AD. “In high school, it would be on my hands. I wouldn’t be able to write, because the pencil or pen would rub on the area.” 

Adults

Living with AD also comes with its share of workplace challenges for adults. A 2021 study in the Journal of Asthma and Allergy found that 33.9% of workers living with AD felt discriminated against because of their condition. The same study found that AD was associated with an estimated 10.9 days missed from work per year. Furthermore, AD symptoms, especially during flare-ups, significantly affect individuals’ abilities to perform at work.

The social impacts can be their own challenge to navigate. For Chee, AD impacts the way he feels when meeting new people (such as friends of friends) for the first time or when dating.

Coping Strategies and Treatments

Several medical treatments for AD are available. “Biologic treatments and JAK inhibitors help prevent the inflammatory response that causes AD flare-ups,” says Dr. Geeta Yadav, a board-certified dermatologist and founder of FACET Dermatology. “There’s evidence that these treatments can also help reduce the anxiety and depression associated with AD.”

Topical steroids, topical JAK inhibitors, and other non-steroidal anti-inflammatory medications are also commonly prescribed to treat AD, according to Dr. Yadav. “Controlling flare-ups as well as reducing itch and lesions can go a long way towards improving the mental health and self-esteem of those with AD,” she says.

Finally, lifestyle changes and self-care practices can make a significant difference. Stress reduction plays a major part. Practices such as yoga, breathwork, journaling, and exercise can help. Dr Yadav also suggests the following, if possible: 

Support Systems and Resources

Living with AD can feel isolating. For both Chee and Leonna, support from loved ones has been key. Chee says his family never made a big deal about his condition and helped him put on cream or go to the doctor as a kid. “Friends and people I met who validated the impact [of AD] were also helpful,” he says. 

Similarly, Leonna mentions the care from her friends, family, and partner in helping her cope. “My partner and friends reassure me that it’s okay and doesn’t look as bad,” she says. Leonna says her doctor has helped determine what else can be done to manage her condition. Finally, she mentions Facebook groups and Reddit as sources of support. “They show me how to deal with recurring symptoms and remind me that I’m not alone, that other people are fighting this, too,” she says. “There are ups and downs. It’s not a linear progression to getting better.” 

Speaking to a therapist or joining local support groups can also be useful. Mental health professionals can provide objective insights and help address maladaptive beliefs and coping skills. Connecting with others living with AD can alleviate loneliness and offer tips for how to deal with symptoms, social situations, and other challenges related to the condition.

Additionally, there are several ways to seek support online:

• The National Eczema Association: an organization that offers comprehensive resources through its website, such as a blog and podcast
• Eczema Exchange: an online discussion community and support group that has channels for discussing eczema news, treatment modalities, and alternative healing methods
• Support for Eczema Caregiver Program: a program specifically for parents of children living with eczema, put on by The Global Parents for Eczema Research

Finally, the Asthma and Allergy Foundation of America offers a list of U.S-based support groups for people living with allergy-related conditions, such as eczema. It can also be helpful to ask a healthcare provider if there are support groups hosted locally. 

Bottom Line

Atopic dermatitis is a chronic skin condition that results in redness and irritation. Symptoms of the condition, such as chronic itch, can negatively impact individuals’ mental health. This type of eczema is also associated with academic challenges in children and work-related issues in adults. 

It’s important to bear in mind that AD is a lifelong condition. While treatments and lifestyle changes can improve symptoms or even lead to remission, there is no cure. 

 If you or a loved one is living with AD, it’s important to seek help for both the physical symptoms and emotional challenges that result. Plenty of resources are available, including online and in-person support groups. With the right support and treatment regimen in place, it’s possible to live a healthy and fulfilling life with AD.