Connecting COVID-19 Research to Impact on Patients With Atopic Dermatitis

The intersection between infectious diseases and dermatological conditions has garnered increasing attention, especially over the last 4 years. Amidst the global pandemic caused by the novel coronavirus, SARS-CoV-2, researchers have embarked on a journey to explore potential links between COVID-19 and various skin conditions. This week, Dermatology Times is highlighting recent COVID-19 research affecting skin, hair, and nails. Two studies published this year have shed light on the links between COVID-19 and atopic dermatitis (AD).

Effects on Pediatric Patients With AD

A study conducted at the University of Mississippi Medical Center aimed to evaluate the impact of COVID-19 on pediatric patients with atopic diseases, including asthma, AD, and allergic rhinitis. While research on COVID-19's impacts in atopic individuals has predominantly focused on adults, the emergence of the delta variant and its heightened impact on children necessitated a closer examination of this population. Through a retrospective review of patient data from January 2020 to December 2021, the study analyzed outcomes in 5261 pediatric patients aged 0 to 21 years who tested positive for COVID-19. After applying exclusion criteria, 1420 patients were identified in the atopic cohort, while 2525 were in the non-atopic cohort.¹

The findings revealed notable differences between the 2 groups. The atopic population exhibited a higher incidence of hospitalizations and longer lengths of stay compared to their non-atopic counterparts. Additionally, there was a greater frequency of intensive care unit (ICU) admissions among atopic patients. However, mortality rates and the occurrence of multi-system inflammatory syndrome in children (MIS-C) were comparable between the atopic and non-atopic cohorts. Notably, a greater proportion of atopic patients had a history of inhaled corticosteroid use.

These results underscore the potential severity of COVID-19 in pediatric patients with atopic diseases, highlighting the need for heightened vigilance and tailored management strategies for this vulnerable population. While the study provides valuable insights into the acute impact of COVID-19 on atopic individuals, further longitudinal prospective research is warranted to elucidate the long-term implications of COVID-19 infection on the course and management of atopic diseases in pediatric patients. By continuing to investigate this relationship, clinicians can better understand and address the multifaceted challenges posed by COVID-19 in pediatric populations with underlying atopic conditions.

Observing COVID Outcomes With A Mendelian Randomization Analysis

Another study aimed to investigate the potential causal relationship AD and COVID-19 outcomes using Mendelian randomization (MR) analysis. With frequent hand washing and disinfection practices during the COVID-19 pandemic potentially exacerbating skin-related issues, understanding any association between AD and COVID-19 outcomes was of paramount importance. The research utilized genome-wide association study (GWAS) data from the FinnGen database for AD and data from the COVID-19 Host Genetics Initiative for COVID-19 susceptibility, hospitalization, and severe respiratory disease. The main statistical approach employed was the inverse variance weighted with a fixed effects model (IVW (fe)), alongside other analytical methods to address potential pleiotropy and heterogeneity.²

Analysis using MR revealed no evidence of a causal relationship between AD and COVID-19 outcomes. The odds ratios (OR) obtained from the IVW (fe) method were close to unity for all outcomes: 1.00 (95% confidence interval (CI), 0.99–1.02) for susceptibility, 1.00 (95% CI, 0.96–1.04) for hospitalization, and 0.97 (95% CI, 0.92–1.03) for very severe respiratory disease. Consequently, the study concluded that there is no direct causal link between AD and COVID-19 outcomes.

This research contributes valuable insights by providing clarity on the relationship between AD and COVID-19, thereby offering additional perspectives for exploring risk factors associated with COVID-19. The findings highlight the importance of employing robust analytical approaches like MR to elucidate complex relationships between underlying health conditions and COVID-19 outcomes.

References

1. Rudsenske NE, Perkins JB. Assessing severity of COVID-19 and the development of multi system inflammatory syndrome in children (MIS-C) in pediatric patients with atopic disease. Allergy Asthma Proc. 2024 Mar 1;45(2):92-96. doi: 10.2500/aap.2024.45.230087. PMID: 38449015; PMCID: PMC10926182.
2. Jin C, Li Y. No causal association between atopic dermatitis and COVID-19 outcomes: A Mendelian randomization study. Skin Res Technol. 2024 Feb;30(2):e13619. doi: 10.1111/srt.13619. PMID: 38369908; PMCID: PMC10875392.