Dermatologists urged to treat atopic dermatitis as a systemic disease

Healio's latest report puts a sharp point on a slow-moving shift in dermatology: atopic dermatitis (AD) shouldn't be managed as a skin-only condition. Every patient encounter should include a deliberate screen for cardiovascular, respiratory, and psychiatric comorbidities that travel with the disease.

The argument isn't radical on its face. AD has been linked to asthma, allergic rhinitis, and food allergy for decades — the so-called atopic march, the cluster of atopic conditions that develops in a predictable sequence during childhood.

What's newer is the framing of AD as a driver of cardiovascular risk and mental-health burden in adults, particularly those with moderate-to-severe disease. Cohort studies have repeatedly shown higher rates of myocardial infarction, stroke, and all-cause mortality in AD populations, alongside a meaningful elevation in anxiety, depression, and sleep-disorder diagnoses.

The comorbidity checklist that follows is short but specific. On the cardiovascular side: blood pressure, lipid panel if not done in the last year, and a smoking history. On the respiratory side: a single question on wheezing or nighttime cough, plus confirmation of asthma or allergic rhinitis status. On the psychiatric side: the PHQ-2, with a PHQ-9 follow-up if either item screens positive.

Why now

The timing isn't accidental. The AD treatment landscape has shifted sharply over the last five years, with IL-4/IL-13 biologics and JAK inhibitors moving systemic and targeted therapy into mainstream practice for moderate-to-severe patients.

Each drug class carries its own comorbidity considerations — and each prescription decision is implicitly a screening decision. A patient on a JAK inhibitor is already getting a baseline cardiovascular workup as part of label-driven safety monitoring.

A biologic candidate gets screened for parasitic infection risk and watched for new ocular symptoms. The Healio argument is that this screening logic should extend to every AD patient, not just those stepping up to systemic therapy.

What changes for a busy practice?

Three workflow items, mostly.

First, the visit template. Even a 15-minute follow-up can absorb a blood pressure reading, one respiratory symptom question, and a brief mood check. None of these require new staff, but they do require the practice to commit to doing them every time on every moderate-to-severe AD patient.

Second, the referral network. AD care is increasingly multidisciplinary — dermatology, allergy, primary care, and psychiatry need to be on the same page. Practices with a clear handoff protocol, including a named contact at each receiving specialty, report fewer dropped referrals and faster turnaround on comorbid diagnoses.

Third, the documentation. Capturing comorbid depression, hypertension, or asthma in the visit note changes the risk profile of the patient and, in some payer contracts, the risk-adjustment and reimbursement calculation. The work has to show up in the chart, not just in the dermatologist's head.

The open question

The bigger unresolved issue is who owns the comorbidity screen. Primary care already screens for cardiovascular risk and depression, and most moderate-to-severe AD patients should already have a primary care relationship.

Dermatology's case is that the AD patient is showing up in front of them first, with skin in hand, and the visit is the right moment to start the conversation — even if the formal follow-up lives elsewhere.

Expect the next iteration of AD guidelines to formalize this — likely the AAD's atopic dermatitis guideline update and the harmonized European documents — as a short, severity-tied checklist with explicit referral triggers. The question for practices now isn't whether to add the step, but how to absorb it without lengthening the visit.