28 December 2018

Eczema can drive people to thoughts of suicide

A study found that people with eczema had a considerably higher risk of suicidal thoughts compared with people without the immunological disease.

Nearly 28 million Americans are affected by the skin condition eczema, and for some it may become so chronic and severe they consider suicide, new research shows.

A new review of data from 15 studies, involving over 300 000 people, found that those with eczema had a 44% higher risk of suicidal thoughts compared with people without the immunological disease.

People with eczema also had a 36% higher rate of suicide attempts, the study found.

Painful itch, blisters and sores

Eczema, clinically known as atopic dermatitis, often brings a "profound psychosocial burden" to patients, concluded a team led by Dr April Armstrong, of the University of South California (USC) Keck School of Medicine, Los Angeles.

Eczema is an inflammatory skin condition that often involves painful itch, blisters and sores. People can also have trouble sleeping due to itchiness and other symptoms.

The disease can vary in severity and can be socially debilitating, prior research has shown. One such study involved 600 eczema patients interviewed by researchers at Northwestern University in Chicago.

That study found that even for people with mild eczema, nearly 18% said they avoided socializing because of their appearance, while 23% said they limited their daily activities. Those figures rose to 40% and 43%, respectively, when moderate and severe patients were included.

The findings were published in the Annals of Allergy, Asthma and Immunology.

Shame, embarrassment and stigmatisation

In the new study, the USC team found similar issues plaguing eczema patients.

"Because of the visibility of the disease, patients may experience shame, embarrassment and stigmatisation," Armstrong's team said. This can affect a child's performance at school or an adult's ability to thrive in the workforce, they explained.

To learn more, the investigators analysed data from 15 studies on eczema's emotional toll on patients.

The findings showed that "patients with atopic dermatitis are at significantly greater risk of suicidal ideation and suicide attempts", and the level of distress rose along with the severity of the skin disease, according to the report.

For example, while less than one percent of people with mild eczema said they had suicidal thoughts, that number rose to nearly 20% for those with severe disease, the researchers found.

Concurrent health issues

Two skin specialists weren't surprised by the findings.

Eczema "can be mentally stressful for patients who suffer from it," said Dr Michele Green, a dermatologist at Lenox Hill Hospital in New York City. She believes the study reinforces the need for treatments that minimise the illness, to help patients mentally cope.

Dr Raman Madan practices dermatology at Northwell Health's Huntington Hospital in Huntington, New York. He said that people with eczema often have to deal with concurrent health issues – conditions such as asthma, allergic rhinitis (hay fever), metabolic syndrome and sleep disturbances.

Now, the new study "casts light that dermatologists should screen for mental health in [these] patients," as well, Dr Madan said.

For their part, Armstrong's team stressed that treatments that ease eczema severity are available.

Immune-targeted treatments, "such as interleukin 4 and interleukin 13, have been shown to decrease symptoms of depression and anxiety in patients," the study authors wrote. And as physical symptoms subside, and the social stigma around the illness eases, "we can work toward reducing suicidality in patients with [eczema]," the team noted.

The new findings were published online in JAMA Dermatology.

Image credit: iStock