Common eczema linked to higher rates of suicidal thoughts, large study finds

Adults with atopic eczema were significantly more likely to report suicidal thoughts than those without the condition, according to results presented at the European Academy of Dermatology Congress in Paris. The analysis of more than 30,800 adults across 27 countries found that just over 13% of people with the common inflammatory skin disorder reported suicidal ideation, compared with 8.5% of adults without atopic eczema.

Investigators examined associations between suicidal thoughts and clinical and psychosocial features in one of the largest studies of its kind. The research included more than 15,200 people with atopic eczema, matched with 7,968 controls, and grouped patients by age at diagnosis — childhood, adolescence or adulthood. Participants completed questionnaires recording symptom severity, experiences of skin-related stigmatization and any history of suicidal thoughts.

The study identified several factors associated with higher rates of suicidal ideation. Younger adults, particularly those under 30, were more likely to report suicidal thoughts. Clinical severity was a major driver: individuals with moderate to severe symptoms had greater risk than those with milder disease. Researchers also linked mixed insomnia — difficulty falling and staying asleep — and higher levels of perceived stigmatization to an increased likelihood of suicidal ideation. Obesity was another factor associated with raised risk.

"The results highlight that the effects of atopic eczema are more than skin deep, with suicidal thoughts representing a serious and frequent concern that is often overlooked by healthcare professionals," said Dr. Delphine Kerob, a contributing lead author of the study. She said the team hoped the findings would help clinicians better recognise and address mental-health risks in patients with inflammatory skin conditions.

Dermatologists have long reported a substantial psychosocial burden from atopic dermatitis, also known as atopic eczema. The condition causes itchy, cracked and dry skin that can blister and bleed during flares and is commonly treated first with prescription washes and topical steroid creams. In more severe cases, systemic immunosuppressant drugs are used, with potential side effects on immunity and the liver.

"Atopic dermatitis often has a greatly underestimated psychosocial burden for the patients and their families," said Professor Tony Bewley, a consultant dermatologist at Bart's Health NHS Trust in London. "Both adults and children frequently face stigmatisation, loss of confidence and bullying, sleep deprivation and overwhelming itch, which may impact their performance at school and work. In severe atopic dermatitis, patients often suffer from depression, anxiety and even suicidal ideation."

The research comes as health services expand treatment options for severe disease. The NHS last year announced the roll-out of lebrikizumab, an injected therapy that targets a protein involved in inflammation and is intended to reduce painful symptoms. Advocates and clinicians have welcomed the additional option as a step forward for patients with refractory disease.

Public-health estimates cited by the researchers underline the scale of the issue: more than 5.2 million adults and 2.5 million children in the United Kingdom are thought to have moderate to severe eczema. The authors and commentators urged greater attention from healthcare providers to the mental-health needs of people with chronic skin disease, including screening for sleep disorders, assessment of psychosocial impact and referral to appropriate psychological support when indicated.

The presenting team said further work is needed to clarify pathways linking skin disease to suicidal ideation and to develop interventions that reduce both physical symptoms and psychological distress. For now, the authors recommended that clinicians treating atopic eczema consider routine assessment of mental-health symptoms as part of comprehensive care.