Psychiatric and Psychological Approach in Patients with Atopic Dermatitis, Hidradenitis Suppurativa and Psoriasis: A Propensity-Matched Real-World Cohort Study.

INTRODUCTION: Chronic inflammatory dermatoses-atopic dermatitis (AD), hidradenitis suppurativa (HS), and psoriasis (PsO)-are linked to elevated rates of psychosocial consequences. Beyond controlling cutaneous inflammation, contemporary care should address psychosocial well-being, yet real-world evidence on psychiatric and psychological service use in these diseases is limited. To quantify the prevalence and risk of psychiatric evaluation, psychotherapy, and psychiatric pharmacotherapy among adults with AD, HS, and PsO versus matched controls, and to examine sex-specific differences.

METHODS: Using deidentified electronic health records from the international TriNetX network, we identified adults newly diagnosed with AD, HS, or PsO and matched each disease cohort 1:1 to control patients without the index dermatosis or prior mental disorders. Outcomes over 5 years were psychiatric evaluation, psychotherapy, and psychiatric medications (sedatives/hypnotics, anticonvulsants, antidepressants, antipsychotics). Risks were estimated with generalized linear models (risk ratios (RRs)) and Cox models (hazard ratios (HRs)), with sex-stratified analyses.

RESULTS: After matching, the study included 447,821 AD pairs, 123,443 HS pairs, and 443,598 PsO pairs with balanced demographics and comorbidities. All dermatoses showed higher utilization than controls. In AD, psychotherapy displayed the largest relative increase (RR≈3.0); psychiatric evaluation and treatment were also elevated (RRs ≈2.6 and ≈1.35). In HS, risks were higher for psychiatric evaluation, psychotherapy, and especially psychiatric pharmacotherapy (RR ≈1.75). In PsO, psychiatric evaluation, psychotherapy, and psychiatric treatment were all increased (RRs ≈1.9, ≈1.9, and ≈1.34, respectively). Sex-stratified analyses showed women with AD had greater risks across all outcomes; in HS, only psychiatric pharmacotherapy was higher in women; in PsO, men had slightly higher pharmacotherapy use.

CONCLUSIONS: Adults with AD, HS, and PsO have substantially greater psychiatric and psychological care utilization than matched controls, with meaningful sex differences. Findings support integrated, multidisciplinary management that proactively addresses mental health alongside dermatologic treatment.