Psychiatric Comorbidities in Atopic Dermatitis – A Narrative Review Focusing on Depression and Anxiety

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting both children and adults worldwide. Beyond its dermatological manifestations, AD often leads to sleep disturbances, persistent itch, and discomfort, which may contribute to elevated levels of anxiety and depression. The disease’s relapsing course and visible skin lesions can further impact social functioning and quality of life, highlighting the need to understand its psychological burden. This review aims to summarize current evidence on the impact of pruritus and sleep disturbances on depression and anxiety in patients with atopic dermatitis, explore potential biological mechanisms, and discuss their effects on patients’ quality of life and clinical implications. Methods: A narrative literature review was conducted using PubMed and Google Scholar, including original studies, population-based analyses, clinical trials, and relevant reviews addressing psychological outcomes in both paediatric and adult populations. Results: Depression and anxiety are among the most common psychiatric comorbidities in AD, with prevalence estimates showing considerable variability across studies. Their occurrence and severity are closely associated with disease severity, chronic pruritus, and sleep disturbances. Pruritus and sleep disruption emerge as key mediators linking dermatological symptoms with psychological distress. In addition to psychosocial factors such as visible skin lesions and social stigma, biological mechanisms—including immune dysregulation, increased pro-inflammatory cytokine activity, and alterations of the hypothalamic–pituitary–adrenal axis—may contribute to increased vulnerability to mood disorders. Conclusions: Despite the high prevalence of psychiatric symptoms, mental health assessment remains insufficiently integrated into routine AD care. Early identification and multidisciplinary management are essential. Future research should focus on prospective studies evaluating integrated therapeutic approaches to improve both mental health outcomes and overall quality of life in patients with AD.