News recently hit the headlines, both in the British Medical Journal and the media, that eczema has joined the list of conditions which are linked to heart disease and stroke.
How could that be? How is the skin so closely related to disease of the heart and blood vessels?
The type of eczema implicated is one called atopic, which means it runs in families, often affects babies and is commonly accompanied by asthma and hayfever.
Eczema is a type of inflammation in the skin and while cardiovascular disease (CVD) has been linked to another skin disease, psoriasis, no link has been previously shown in eczema.
But we must take notice of this new study because it reports on 387,439 UK adults with atopic eczema compared to 1,528,477 controls, making it very powerful.
Not everyone with atopic eczema will have a raised risk of heart disease.
Those who are vulnerable are those whose eczema is severe, defined as needing treatment at least twice a year.
During an average of five years of follow-up after initial diagnosis, the risk of CV death was 30% higher in patients with severe eczema, the risk of heart failure was 70% higher, and risks of heart attack, angina and atrial fibrillation were about 40% higher than in a control group.
Severe eczema was also associated with a 20% increased risk of stroke. All the risks increased the worse the eczema was.
This new link between severe eczema and CVD affects both patients and doctors.
For patients who have severe or recurring eczema, the evidence from this study makes a strong case for regular screening for CV risk factors such as high blood pressure, obesity, smoking and a sedentary lifestyle.
Doctors may need to rethink how they monitor patients with severe eczema factoring in the need for long-term regular cardiac checks. It also falls to doctors to advise their eczema patients on how to lower their risk of heart disease.
The results also make a case for putting more investment into medical research on eczema.
Prevention of CV disease by better control of severe eczema will also mean participants can have access to expensive new biologic drugs that are becoming available for treating atopic eczema.
Of course we don’t yet know for sure that these eczema drugs reduce CV events in patients with severe eczema. It’s the next important step.
Researchers will have to track prevention of CV disease in long-term eczema trials.
In fact, no such trial should be set up without scrutiny of heart health and eczema.