Treating Body and Mind in Atopic Dermatitis: Priorities for Primary Care

Primary care clinicians hold a unique position in the care of patients with atopic dermatitis; they often serve as the only clinician who sees both the visible skin disease and the less obvious toll it takes on daily functioning, relationships, and emotional wellbeing.

It has become clear that psychiatric comorbidities are common, predictable, and frequently overlooked. Yet with straightforward screening questions, attention to functional outcomes alongside clinical measures, and appropriate thresholds for specialty referral, primary care can become a critical point of intervention that prevents years of accumulated psychological burden.

The goal extends beyond controlling inflammation to restoring a patient's ability to participate fully in life—at school, at work, and in relationships that matter. This shift in perspective, from managing a rash to supporting a person, is what transforms routine dermatologic care into genuinely life-changing medicine.

The following takeaway points summarize the key themes in this 6-article series.

Key Takeaways

✓ Depression and anxiety affect up to 25% of AD patients - mental health screening should be routine

✓ Early-onset disease has lifelong psychosocial impact - even after skin clears, psychological effects can persist

✓ Adolescents carry particularly high burden - warranting lower threshold for referral and aggressive treatment

✓ Key risk factors: pruritus, sleep disorders, disease severity, and comorbidities predict mental health problems

✓ PCPs manage 80% of AD - you are often the only clinician seeing the whole picture

✓ Early, aggressive treatment may prevent long-term psychological burden - treatment timing matters for mental health outcomes

✓ Referral thresholds: moderate-severe disease OR significant quality of life impact - either alone warrants specialist evaluation

✓ Address the patient, not just the rash - functional outcomes and quality of life are as important as EASI scores

✓ Mental health and skin treatment should be simultaneous - don't wait for one to improve before addressing the other

References

• Mental health burden in atopic dermatitis: Study identifies key risk factors for anxiety and depression. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/mental-health-burden-in-atopic-dermatitis-study-identifies-key-risk-factors-for-anxiety-and-depression
• When is it time to refer? A dermatologist considers atopic dermatitis treated in primary care. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/when-is-it-time-to-refer-a-dermatologist-considers-atopic-dermatitis-treated-in-primary-care
• Why is early treatment of atopic dermatitis so important? Mona Shahriari, MD, says it could change a life. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/why-is-early-treatment-of-atopic-dermatitis-so-important-mona-shahriari-md-says-it-could-change-a-life
• Burden of moderate to severe atopic dermatitis weighs heavily on children and adolescents: Real-world analysis. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/burden-of-moderate-to-severe-atopic-dermatitis-weighs-heavily-on-children-and-adolescents-real-world-analysis
• Early-onset atopic dermatitis significantly impacts psychosocial development, wellbeing throughout adult life. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/early-onset-atopic-dermatitis-significantly-impacts-psychosocial-development-wellbeing-throughout-adult-life
• Millions of US adults have multiple forms of eczema, study finds. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/millions-of-us-adults-have-multiple-forms-of-eczema-study-finds
• The toll of atopic dermatitis is more than skin deep: Q & A with Harvard child psychologist Jennifer LeBovidge, PhD. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/the-toll-of-atopic-dermatitis-is-more-than-skin-deep-q-a-with-harvard-child-psychologist-jennifer-lebovidge-phd
• Q&A: Cumulative life course impairment of atopic dermatitis with Mona Shahriari, MD. Patient Care Online. Accessed November 19, 2025. https://www.patientcareonline.com/view/q-a-cumulative-life-course-impairment-of-atopic-dermatitis-with-mona-shahriari-md