Inflammatory Skin Disease (Eczema) Linked to Higher Risk of Depression and Anxiety

Chunbo LI – Shanghai Arch Psychiatry, 2025

People with atopic dermatitis (eczema) face elevated risks of depression and anxiety, likely driven by chronic inflammation, sleep loss, visible symptoms, and itch-pain cycles. New syntheses and large datasets clarify how skin inflammation connects to mental health, and where better care can help.

Glossary

Oral Cancer: A type of cancer occurring in the mouth, including lip, tongue, gum, and floor of mouth cancer.
Pain Beliefs: An individual’s feelings, perceptions, and thoughts about their pain experience, categorized as negative (e.g., catastrophizing, helplessness) or positive (e.g., self-efficacy, control).
Belief Modification: An intervention approach aimed at identifying and changing incorrect or unhelpful pain beliefs to improve pain management and outcomes.
Common-Sense Model (CSM) of Self-Regulation: A theoretical framework describing how individuals form beliefs about illness (identity, consequences, cause, timeline, cure/control, coherence) which influence their coping responses and outcomes.
Acceptance-Based Pain Management: Interventions focusing on accepting the presence of pain without trying to control it, often combined with mindfulness or relaxation techniques.
Cancer Pain Belief Modification Program (CPBMP): A six-module intervention program developed in the study based on modifying pain beliefs using CSM and acceptance techniques for Chinese oral cancer patients.

Key Points

The study developed and tested the acceptability and preliminary outcomes of the Cancer Pain Belief Modification Program (CPBMP) for Chinese oral cancer survivors.
CPBMP showed significant improvements in pain intensity, negative and positive pain beliefs, and quality of life in a small pre-post trial.
The program is based on the Common-Sense Model and incorporates acceptance strategies, aligning with Eastern cultural concepts.
The intervention was found to be acceptable to participants.
The main limitations were the small sample size and short follow-up period in the feasibility study.

Study at a Glance

Journal & Date: BMC Health Services Research, November 2023 — Development and preliminary evaluation of a cancer pain belief modification program for Chinese oral cancer survivors: a mixed-methods study
Study Design & Population: Mixed-methods study including a literature review, qualitative interviews (n=15), Delphi expert review (n=15), and a single-group pre-post feasibility trial (n=16) conducted in China.
Primary Outcomes: The CPBMP was deemed acceptable. Significant improvements were observed in pain intensity (NRS), negative pain beliefs (IPQ-CaCP), positive pain beliefs (IPQ-CaCP), and quality of life (UW-QOL) scores from pre- to post-intervention.

What’s New vs Prior Evidence

Earlier meta-analyses established that eczema correlates with higher depression/anxiety risk, but effect sizes and age-group patterns varied. Newer, very large UK primary-care cohorts strengthen the association across dozens of outcomes and better stratify by severity, comorbidity, and age. The 2025 Nature feature integrates mechanistic context (neuro-immune signaling, cytokines (IL-4/IL-13), and itch-sleep loops) and highlights clinician observations that controlling inflammation often improves sleep, mood, and quality of life.

Emerging studies map psychosocial drivers (stigma, visibility of lesions) alongside biological pathways, suggesting multi-factor causation.

Overall, the evidence base is more coherent than in 2020–2022, but causal inference remains limited without trials designed with mental-health endpoints.

Expert Comment

Professor Carsten Flohr, Foundation Director of the International Eczema Council and lead investigator for large cohort studies such as A-STAR and DREAM to TREAT AD, explains:

“Atopic dermatitis is more than skin deep: it is the chronic inflammation, itch-sleep loop, and psychosocial stress often converge to affect mood and mental well-being. Our UK-based cohort data confirm that adults with eczema, especially moderate to severe forms, face significantly higher chances of developing depression and anxiety, and this risk appears to rise with disease severity. Patients often report that when their inflammation clears, their sleep and mood improve, but we need trials that include mental-health outcomes to confirm this effect objectively. We must also not overlook the role of skin-related shame and visibility in creating emotional distress; these social factors may be as influential as the biological pathways. Ensuring access to approved treatments, including newer biologics, is vital, but so is integrating psychological screening and support into dermatologic care. Going forward, collaborative trials that test both biologic and behavioral interventions, and that include diverse populations, are key to closing the evidence gap and improving overall quality of life for people with eczema.”

Who Could Benefit

Patients with eczema may gain not only skin relief but also improvements in mood and sleep if inflammation is brought under better control.
Families and caregivers could benefit from greater awareness that mood changes and fatigue are part of the disease burden, not just “side issues.”
Clinicians in dermatology, psychiatry, and primary care may use this evidence to coordinate treatment plans that address both skin and mental health together.
Researchers and policymakers can identify priority areas for funding large-scale trials and for creating guidelines that integrate psychological screening into eczema management.

Limitations & Uncertainties

Most of the available evidence comes from observational studies, which can show associations but cannot prove that eczema directly causes depression or anxiety.
Effect sizes vary across age groups, ethnic backgrounds, and disease severity, making it difficult to apply a single risk estimate to all patients.
Few randomized controlled trials of eczema therapies include mental-health outcomes as endpoints, so it remains uncertain how much symptom control translates into improved mood in a measurable way.
Social and environmental factors may contribute to the observed link, but these are rarely captured in large datasets.

What Happens Next

Expect more prospective cohorts integrating dermatologic severity, sleep actigraphy, and standardized mental-health scales to tease mechanisms and effect sizes. RCTs of anti-inflammatory therapies and adjunct sleep/psychological interventions should pre-specify depression/anxiety outcomes and test durability after flare control.

Summary

Eczema doesn’t just affect the skin, it can also make depression and anxiety more likely, partly because itching and poor sleep wear people down and inflammation affects the body’s stress systems. Treating inflammation and itch often helps people sleep and feel better, but researchers still need [more] trials to prove cause and effect.

References

Keener, A. (2025, August 27). Explaining the mental-health burden of atopic dermatitis. Nature. https://doi.org/10.1038/d41586-025-02646-z
Matthewman, J., et al. (2024). Cohort studies on 71 outcomes among people with atopic eczema using UK primary-care records (1997–2023). Nature Communications, 15, Article 54035. https://doi.org/10.1038/s41467-024-54035-1
Rønnstad, A. T. M., et al. (2018). Association of atopic dermatitis with depression, anxiety, and suicidal ideation: Systematic review and meta-analysis. Journal of the American Academy of Dermatology, 79(3), 448–456. https://doi.org/10.1016/j.jaad.2018.03.017
Liu, K., et al. (2025). Risk factors for anxiety and depression in patients with atopic dermatitis: Cross-sectional analysis. BMC Psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC12188848/