TOPLINE:

In a retrospective cohort study, patients with atopic dermatitis (AD) had 1.47-fold higher odds of non-atopic multimorbidity, with those with moderate-to-severe disease demonstrating unique orofacial and cardiometabolic disease patterns.

METHODOLOGY:

• This retrospective observational study included 37,193 adult participants (mean age, 47.2 years; 59% women) from the Lifelines cohort in Netherlands with data on the presence of AD and chronic diseases.
• Baseline evaluations took place between 2006 and 2013, with follow-up visits every 5 years. Overall, 8.7% of patients reported a lifetime physician diagnosis of AD through self-report questionnaires.
• Researchers assessed the lifetime prevalence of 52 diseases other than AD across 15 physiologic domains through questionnaires, medication records, clinical examinations, laboratory tests, electrocardiography, and spirometry between 2006 and 2024.
• Outcomes included associations between the presence or severity of AD and multimorbidity patterns. Multimorbidity was defined as the presence of two or more diseases excluding AD in the same individual; non-atopic multimorbidity, defined as the number of confirmed diseases excluding asthma, rhinitis, and food allergy, was determined using a composite morbidity score (cMS) with an upper bound of 5 or greater.

TAKEAWAY:

• The prevalence of non-atopic multimorbidity was significantly higher in patients with AD than in those without AD (47.8% vs 43.1%; P < .001) and in patients with moderate-to-severe disease than in those with mild disease (49.7% vs 47.1%; P < .001). The prevalence of multimorbidity including atopic diseases was significantly higher in patients with AD than in those without AD (64.9% vs 52.4%; P < .001).
• Patients with AD had higher odds of non-atopic multimorbidity (adjusted odds ratio [aOR], 1.47; P < .001), with the odds increasing with disease severity: mild AD (aOR, 1.41; P = .003) and moderate-to-severe AD (aOR, 1.74; P < .001).
• Among patients with a cMS of 5 or greater, the odds of the association between AD and multimorbidity were 2.09-fold higher for non‑atopic cMS and 4.10-fold higher for overall cMS than in patients with no comorbidities.
• Researchers identified five distinct patterns of non-atopic multimorbidity in both groups, with unique orofacial and cardiometabolic signatures in patients with AD.

IN PRACTICE:

"This study showed that individuals with AD, especially those with moderate-to-severe disease, are more likely to experience multimorbidity during their lifetime, even when disregarding atopic comorbidities," the authors wrote. They added "these findings underscore the importance of adopting multidisciplinary frameworks in the management of AD and its comorbidities." 

SOURCE:

The study was led by Leon A. Miltner, Department of Dermatology, University Medical Center Groningen, Groningen, Netherlands. It was published online on November 27, 2025, in British Journal of Dermatology.

LIMITATIONS:

The retrospective design of the study limited the ability to establish chronology and causality between AD and comorbidities. Although AD typically begins before age 6 in about 80% of patients, suggesting it precedes most comorbidities, the sequential analysis identifying individual disease trajectories was not feasible. Selection bias may have been introduced as excluded participants had higher prevalence of AD and a more disadvantageous distribution of lifestyle factors that influenced multimorbidity, although effect sizes were overall low.

DISCLOSURES:

This study was funded by Pfizer Inc. One author disclosed serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Pfizer, LEO Pharma, Regeneron, Sanofi Genzyme, Eli Lilly, and Galderma and receiving grants from Regeneron, Sanofi Genzyme, Novartis, and Pfizer. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.