6 Long-Term Complications of Atopic Dermatitis

When you’re managing atopic dermatitis (AD), a type of severe eczema, you know how frustrating the condition can be. The itchy patches of inflamed skin can feel unbearable. But, what you may not realize is that atopic dermatitis (AD) can also trigger other conditions, such as skin infections, eye complications, and more.

“The body is a whole functioning unit,” says Dawn Davis, MD, an associate professor of dermatology and pediatrics at Mayo Clinic in Rochester, Minnesota. So, what happens in one system can impact another in your body.

How Atopic Dermatitis Affects the Entire Body

Experts say atopic dermatitis can be caused by genetics, environmental factors, or a combination of the two. And, because AD impairs the functions of an essential protein (called filaggrin), the skin is no longer able to safeguard against outside invaders.

“Healthy filaggrin ‘glues’ cells together to build a solid barrier, acting like mortar between bricks,” Dr. Davis explains. Without this protection, your skin becomes dry, damaged, and particularly vulnerable to bacteria, viruses, fungi, allergens, and other irritants, all of which can cause issues that go beyond the skin.

A report published in 2022 found a link between AD and several other health issues, including skin infections, sleep deprivation, psychological problems, and conditions caused by abnormal immune system activity, such as asthma and food allergies.

“We found that about 40 percent of people with AD developed rhinitis, an inflammatory nasal condition; 30 percent had suspected food allergies; and some had both,” says Davis, who was a lead author of the study.

The Most Common Long-Term Complications of Atopic Dermatitis

If you’re living with severe AD, you should look out for these complications:

Skin Infections

Fragile, damaged skin from atopic dermatitis can increase the risk of a staph infection, which causes inflamed skin and pus-filled bumps. AD can also lead to the highly contagious impetigo, a skin infection that causes red bumps. The chance of developing an infection called eczema herpeticum, which is caused by the herpes virus, also rises and can become severe. To ward off these infections, Davis routinely samples and tests atopic dermatitis lesions.

“A skin culture can quickly identify the infection source and point to a particular antiseptic or antimicrobial to suppress it,” she notes.

Asthma and Allergies

AD triples your risk of asthma, which constricts and inflames airways, making it difficult to breathe. Atopic dermatitis also increases the possibility of developing food allergies by 30 percent. Your doctor should ask about your lung health and allergies and refer you to a pulmonologist or allergist when needed.

Eye Problems

If atopic dermatitis makes your eyes itchy, causing you to rub them frequently, you may get pink eye or keratoconus, a rare condition where the cornea gets thinner and forms a cone shape. Both conditions require immediate care by an ophthalmologist. If you experience vision loss, double vision, or crusty, red eyes, call your doctor immediately.

Mental Health Issues

Managing the symptoms and lifestyle implications of AD, such as avoiding certain activities or having lower self-esteem, can take a toll on your mental health and often lead to anxiety and depression. If you’re embarrassed by your inflamed, patchy skin, you may feel like isolating yourself, which makes depression worse. Some people turn to alcohol, nicotine, or drugs to cope, which can lead to a substance use disorder. Dermatologists often recommend psychological counseling, support groups, meditation, or relaxation training for people living with AD.

Sleep Problems

Intense itchiness makes falling and staying asleep challenging. And, being frequently sleep deprived can potentially damage your job performance, personal relationships, and mental stability.

The key to better sleep is getting the itch under control. To do this, your doctor may prescribe antihistamines, over-the-counter topical treatments, or sleep medications. You may also find it helpful to see a therapist or sleep specialist.

Cardiovascular Problems

While research has yet to confirm a definitive link between atopic dermatitis and cardiovascular complications, such as heart attack and stroke, many clinicians consider these diseases anecdotal risks.

“That’s because AD inflammation circulates everywhere, including to the heart and blood vessels,” Davis explains. For people with AD, standard heart screenings are common and could help keep an eye on things.

The Bottom Line

Because severe eczema can cause other health issues, it’s critical to track your symptoms and share them with your doctor. “Record when and how often you have flare-ups, how severe the itching is, and any other medical problems you have,” says Jonathan Silverberg, MD, PhD, an associate professor of dermatology and the director of clinical research and dermatology at George Washington University School of Medicine & Health Sciences in Washington, DC.

Don’t be afraid to reach out to your doctor with questions or requests for more help. “The biggest AD issue we face is therapeutic inertia, in which people stay at whatever level of discomfort they are at and don’t seek improvement, because they don’t know what else is out there,” says Dr. Silverberg.