Comorbidities in Immune-mediated Skin Disorders: What’s Coming

Comorbidities in immune-mediated skin disorders (IMSDs) occur frequently and have a significant impact on disease severity, treatment, prognosis, and quality of life. IMSDs are a group of skin diseases in which the immune system plays a central role in inflammation. Chronic inflammation and autoimmunity lead to an array of comorbidities. Hidradenitis suppurativa (HS), alopecia areata (AA), vitiligo, atopic dermatitis (AD), and psoriasis (PsO) are some of the more common IMSDs with many comorbidities. Highlighting these comorbidities is critical for the improvement of disease burden and quality of life. Here, we provide a helpful summary of the most frequent comorbidities (see Table). Comorbid conditions in which associations are controversial or that have less vigorous evidence in the current available literature are also marked in the Table. 

 In a coming series of reviews, we will discuss these comorbidities in more detail. We will be reviewing available literature on comorbidities in each condition and discuss the current evidence. Research continues into etiology, pathogenesis, and comorbid associations of IMSDs, the results of which increase our knowledge on each category. Some associations have been recognized and examined more vigorously, providing new information. For example, psoriasis has now been recognized as an independent risk factor for cardiovascular disease. Other comorbid conditions, such as arthritis associated with atopic dermatitis and metabolic syndrome associated with vitiligo, are actively being investigated. 

Importantly, we will be reviewing the strength of evidence on associations of various comorbidities with IMSDs. 

The hope is that this information provides a toolbox for the astute clinician to better recognize, screen, and manage these comorbidities. Altogether, we feel this can contribute to a more holistic approach to IMSDs, with an end goal of improving the quality of care for patients. 

Disclosures for Brad P. Glick, DO, MPH, FAAD (key: A, advisor; I, investigator; S, speaker): AbbVie (I,A,S); Arcutis Biotherapeutics (I,A,S); AstraZeneca (I); Amgen (I,A,S); Janssen (S); BMS (I,A,S); Brickell Biotech (I); Cara Therapeutics (I); ChemoCentryx (I); CorEvitas Registry PSO (I); CorEvitas Registry AD (I); Dermavant Science (I,A,S); Dermira (I,A,S); EPI/Novan (A,S); Galderma (I,A); Incyte (A,S); Leo Pharma (I,A,S); Lily (I,A,S); Nimbus/Lakshmi, Inc. (I); Novartis (A,S); Ortho Dermatologists (A,S); PROSE Registry for AD (I); Pfizer (A,S); Regeneron (S); Sanofi/Genzyme (A,S); Sun Pharma (I,A,S); UCB (A,S); Top MD (stock holder).

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Neda Ghiam, MD, MS

• PGY-3 Resident Physician at Larkin Palm Springs Dermatology Program, 
  Miami, FL

Amit Sharma, DO

• PGY-4 Resident Physician at Larkin Palm Springs Dermatology Program, 
  Miami, FL

Brad P. Glick, DO, MPH, FAAD

• Dermatology Residency Program Director
• Larkin Health System - Palm Springs Campus, Miami, FL