Risk of systemic infections in adults with atopic dermatitis: a nationwide cohort study

Catherine Droitcourt (1, 2) , Ida Vittrup (3, 4) , Sandrine Kerbrat (2) , Alexander Egeberg (3, 4) , Jacob P Thyssen (3, 4)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
3 Herlev and Gentofte Hospital
4 UCPH - University of Copenhagen = Københavns Universitet

Background - Atopic dermatitis (AD) has been linked to systemic infections in adulthood, but large-scale studies are few, and potential associations are unclear. Objective - To examine whether adults with AD have increased risk of developing systemic infections leading to hospital-based management. Methods - Nationwide register-based cohort study including all Danish adults from 1995 through 2017. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by using Cox models. Results - A total of 10,602 adults with AD (median age, 29.8 y; interquartile range, 22.6-44.8) and 106,020 reference individuals were included. The overall incidence rate per 10,000 person-years of systemic infections was 180.6 (95% CI, 172.6-189.0) among adults with AD compared with 120.4 (95% CI, 118.3-122.5) among reference adults. The association between AD and systemic infections was observed for musculoskeletal (adjusted HR [aHR], 1.81; 95% CI, 1.42-2.31), heart (aHR, 1.75; 95% CI, 1.21-2.53), and upper (aHR, 1.42; 95% CI, 1.15-1.73) and lower respiratory tract infections (aHR, 1.21; 95% CI, 1.10-1.33). The risk of sepsis (aHR, 1.19; 95% CI, 1.01-1.44) and skin infections (aHR, 2.30; 95% CI, 2.01-2.62) was also increased. Limitations - The findings cannot be generalized to adults with milder AD seen outside the hospital system. Conclusion - We found an increased risk of systemic infections among adults with hospital managed AD.

Mots clés: adulthood; atopic dermatitis; epidemiology; risk; systemic infections

Domaines: Sciences du Vivant [q-bio]; Dermatologie

Catherine Droitcourt, Ida Vittrup, Sandrine Kerbrat, Alexander Egeberg, Jacob P Thyssen. Risk of systemic infections in adults with atopic dermatitis: a nationwide cohort study. Journal of The American Academy of Dermatology, 2021, 84 (2), pp.290-299. ⟨10.1016/j.jaad.2020.07.111⟩. ⟨hal-02931639⟩