Emotional Red Flags in Atopic Dermatitis: What to Screen For

Identifying the mental health burden of atopic dermatitis (AD) requires moving beyond questions about skin symptoms to explore the broader impact on patients' lives. Simple screening questions integrated into routine visits can uncover hidden suffering and guide treatment decisions. "A lot of times, as clinicians, we focus on objective skin scores, like achieving a certain EASI score or an IGA score, but the reality is, the skin doesn't always tell the whole story.

"This disease has a multidimensional burden that goes far beyond what we can see or [even] what the patient can see," dermatologist Mona Shahriari, MD, assistant clinical professor of dermatology at the Yale School of Medicine, said in a recent interview with Patient Care.^©8

"I routinely ask questions like, 'Having eczema can sometimes make people feel down or anxious—do you ever feel that way?' or 'Is there anything you're not doing because of your eczema?' These kinds of questions give us critical insight into the lived experience of the disease and help redefine what adequate control really means," shd added.8

In the Office: Questions to Ask

Beyond assessing skin clearance and itch severity, consider incorporating these questions into your AD visits. These are based on Patient Care interviews with Shahriari and other leading dermatologists in 2025 as well as research in the current AD literature:

Sleep and Functioning

• "How is your sleep?" (or for caregivers: "How is your child sleeping?")
• "Are you missing work/school because of your skin?"
• "How much time do you spend managing your skin each day?"

Emotional Impact

• "How does your skin affect your mood?"
• "Do you ever feel anxious or down about your skin condition?"
• "Has your skin kept you from doing things you enjoy?"

Social Functioning

• "Do you avoid social situations because of your skin?"
• "How comfortable do you feel in situations where your skin is visible?"
• "Has your skin affected your relationships?"

For Adolescents Specifically

• "Do kids at school ever comment on your skin?"
• "Does your skin make it hard to focus on schoolwork?"
• "Do you feel self-conscious about your appearance?"

These questions can be woven naturally into the visit and don't require formal screening instruments, though validated tools like the Patient Health Questionnaire-9 (PHQ-9; depression) or General Anxiety Disorder-7 (GAD-7; anxiety) can be used when concerns arise.

Warning Signs

Certain clinical presentations should immediately raise concern about significant psychological burden^3-5,8:

• Social withdrawal - Patient reports avoiding activities, declining invitations, or isolating at home
• Frequent absences - Missing work or school regularly due to skin symptoms or associated distress
• Sleep deprivation - Chronic sleep disruption from itching leading to daytime dysfunction
• Expressed hopelessness - Statements suggesting nothing will help or treatment is futile
• Visible distress - Patient or caregiver becomes emotional when discussing the disease
• Treatment non-adherence - May reflect depression, hopelessness, or inadequate disease education

"When a patient with AD walks into your clinic, it might feel like just another rash on the schedule. But for them, it could be the reason they don’t leave the house" Shariari stressed. "It could be the reason they don’t fall in love. It could be the reason they stop dreaming. Taking the time to ask the right questions, to understand the full burden of disease, and to start effective treatment—those things can genuinely transform lives."³ She emphasized that severe psychosocial impairment warrants the same clinical urgency as severe skin disease.³

NEXT: Intervene Early in AD to Avoid Lasting Psychological Impact