ADHD, Skin Disease May Be Linked

Children With Eczema More Likely to Get Attention Deficit Disorder

From the WebMD Archives

March 25, 2003 (San Francisco) -- Babies and children who are prone to itchy, inflamed rashes -- a condition called eczema -- often suffer from sleeplessness and irritability. Worn-out parents and suffering children make frequent visits to pediatric offices seeking relief for this inflammatory skin condition, but new research suggests that it may be more than skin deep.

Typically, people with eczema also have asthma and other allergies, but it is the skin condition that can be most disruptive in young children. Anything from soap to the family pet can cause the skin to become extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling.

Now, a study of more than 43,000 children with eczema suggests that these kids are also at increased risk for a diagnosis of attention deficit disorder (ADHD).

Lead researcher Kristijan Kahler, MS, RPH, associate director of health economics and outcomes at Novartis Pharmaceuticals Corp. in East Hanover, N.J., tells WebMD that the new study doesn't conclude that eczema causes ADHD but it does point to a clear association.

But what is behind this observed association is still not clear. Kahler says, for example, that children with eczema are "up more nights and [are] more irritable than [children without eczema], and these children do make more physician visits, and these factors may contribute to increased diagnosis."

In fact, it was an observation by a Pennsylvania pediatric dermatologist, who happened to notice that several of his young eczema patients were also turning up with new ADHD diagnoses, that led Kahler and his colleagues to study the question.

They analyzed both medical records and prescription records from a pharmacy database to identify children with eczema in 1999. They then checked the medical and pharmacy records for these children in 2000 and 2001. Those records were compared with a group of "controls" -- children who were the same age and who had a similar number of doctors' visits, but who weren't diagnosed with eczema. The results were significant: 4.1 of the children with eczema went on to be diagnosed with ADHD, compared with 1.3% of the control group who had a subsequent ADHD diagnosis.

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Moreover, the younger the child with eczema, the greater the increased risk for an ADHD diagnosis.

And the ADHDed diagnosis carries a significant economic impact: The cost of medical care for patients who are dually diagnosed can be almost twice as much.

Dermatologists attending the 61st Annual Meeting of the American Academy of Dermatology, where the new research was presented, were both intrigued and puzzled by the finding.

Alan B. Fleischer Jr., MD, professor and acting chairman of dermatology at Wake Forest University School of Medicine in Winston-Salem, N.C., says, "This is the single study that I was most curious about when we first received the poster abstracts. Clearly this is an observation that demonstrates some association, but what are we to make of this?"

John YM Koo, MD, director of the University of California, San Francisco, Dermatology Drug Research Unit, says the study is reminiscent of "earlier studies from the psychiatric literature that describe a relationship between hyperactive mind and hyperactive body." Koo, who was not involved in the study, says that mind-body theory "has been largely discarded, but this suggests that there may be some relationship."

Sophie Worobec, MD, associate professor of dermatology at the University of Illinois in Chicago, tells WebMD that she's not surprised by the findings. She says the skin and the brain develop about the same time so there is frequently a link between "very reactive skin and very reactive minds." She says that children with eczema are often "very bright. ... I think it is useful to tell parents this. I do this all the time in my practice, and you can observe an almost immediate change in the way the parent regards the child."

She says that a very bright child with eczema presents so many challenges to both parents and teachers that there is a risk that ADHD could be overdiagnosed in such children.

The study was funded by Novartis Pharmaceuticals Corp.

WebMD Health News

Sources

SOURCES: 61st Annual Meeting of the American Academy of Dermatology, San Francisco, March 21-26, 2003. Kristijan Kahler, MS, RPH, associate director of health economics and outcomes, Novartis Pharmaceuticals Corp., East Hanover, N.J. Alan B. Fleischer Jr., MD, professor and acting chairman of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C. John YM Koo, MD, director, University of California, San Francisco, Dermatology Drug Research Unit. Sophie Worobec, MD, associate professor of dermatology, University of Illinois, Chicago.
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