Severe Atopic Eczema Tied to Higher Risk of Premature Death
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There is an increased risk for all-cause and cause-specific mortality among patients with atopic eczema, particularly among those with the most severe or predominantly active disease, according to results of a U.K. population-based cohort study.

"Recent evidence has led to a paradigm shift in how atopic eczema is perceived, from focusing on skin symptoms and associated allergic diseases, to understanding that the disease may be associated with a range of important medical outcomes," researchers from the London School of Hygiene and Tropical Medicine (LSHTM) said.

"However, few studies have assessed if atopic eczema increases the risk of death, a research question we aimed to address in this study," they added.

Using U.K. electronic healthcare records, the researchers matched more than 526,000 adults with atopic eczema (including 34,610 with severe eczema) to 2.5 million adults without the condition. At baseline, participants' median age was 42 years. They were followed for 4.5 years.

The researchers found limited evidence of an increased hazard for all-cause mortality in those with atopic eczema (hazard ratio, 1.04), owing to the low mortality rates overall, but there were somewhat stronger associations (hazard ratios, from 1.08 to 1.14) for deaths due to infectious, digestive, and genitourinary causes. There was a markedly increased mortality risk associated with eczema severity and activity. Patients with severe atopic eczema had a significantly increased risk for mortality (hazard ratio, 1.62) versus those without eczema, with the strongest associations seen for infectious, respiratory, and genitourinary causes.

"Although the absolute risk of death from severe eczema is low, our findings suggest that those with severe or more active forms of the disease do face a higher risk of dying from associated health issues," the researchers said.

Limitations of the analysis include a lack of standardized measures of disease severity. Disease severity was gauged based on hospital referral or receipt of specific therapies, which prevented the researchers from disentangling the effects of treatment and severity.

"Atopic eczema affects up to 10% of adults and is becoming more common globally," the researchers note.

"Right now, we need more research to confirm findings and explore reasons for mortality in severe eczema. But this study has paved the way for future work, which could have a positive health impact for people with severe eczema," they added.