Large US Cohort Highlights Comorbidity Overlap in Inflammatory Skin Disease

New data presented at the 2026 American Academy of Dermatology Annual Meeting highlight the substantial systemic burden associated with both eczema and psoriasis, while also underscoring persistent care gaps—particularly in comorbidity screening and systemic corticosteroid use. Drawing on the National Institutes of Health All of Us Research Program, investigators provided a large-scale, real-world comparison of these 2 common inflammatory skin diseases across a diverse US population.¹

The cross-sectional analysis included 623,464 participants, with 10,449 individuals identified as having eczema and 5,614 with psoriasis. A lymphoma cohort (n = 2,841) served as a reference population. The study evaluated demographic, behavioral, and clinical variables, including cardiometabolic disease, depression, respiratory comorbidities, smoking history, and systemic prednisone exposure.

High Comorbidity Burden Across Both Diseases

Consistent with evolving understanding of chronic inflammatory skin disease as systemic in nature, both eczema and psoriasis cohorts demonstrated substantial comorbidity burdens. Rates of obesity were high in both groups, affecting 43.9% of patients with eczema and 46.5% of those with psoriasis. Similarly, depression prevalence approached nearly half of each cohort (47.1% and 45.6%, respectively), markedly exceeding rates observed in the lymphoma reference group (approximately 28–29%).

These findings reinforce prior literature linking inflammatory skin disease with both metabolic dysfunction and psychiatric comorbidity. Notably, the magnitude of depression observed in this dataset suggests that mental health burden may be underrecognized or undertreated in routine dermatologic practice.

Cardiovascular Risk Signal More Pronounced in Psoriasis

While both conditions were associated with systemic comorbidity, psoriasis demonstrated a stronger signal for cardiovascular and behavioral risk factors. Patients with psoriasis had higher rates of myocardial infarction (8.6% vs 7.1% in eczema), stroke (0.6% vs 0.3%), and smoking history (42.4% vs 34.9%).

These findings align with established evidence linking psoriasis—particularly moderate to severe disease—with increased cardiovascular risk. The elevated smoking prevalence may further compound this risk and highlights the importance of integrating behavioral counseling into dermatologic care.

Unexpected Overlap in Respiratory Comorbidities

Interestingly, asthma prevalence was similar between eczema and psoriasis cohorts (34.6% vs 32.1%), challenging traditional distinctions between Th2-mediated atopic disease and Th1/Th17-mediated psoriasis.

This overlap may reflect shared systemic inflammatory pathways, diagnostic overlap in real-world datasets, or broader environmental and behavioral contributors. These findings suggest that clinicians should maintain awareness of respiratory comorbidities across both disease states, rather than limiting screening based on conventional disease paradigms.

Cognitive and Quality of Life Considerations

Beyond traditional comorbidities, investigators identified a notable proportion of patients reporting difficulty concentrating (6.8%–8.1%). Although not fully characterized, this finding raises the possibility of neurocognitive or quality of life impacts that may be underappreciated in clinical care.

Persistent Use of Systemic Corticosteroids

One of the more clinically actionable findings was the high rate of systemic prednisone exposure in both groups, with approximately one-third of patients receiving corticosteroids.

Given the well-documented risk of disease rebound and flare in psoriasis, as well as broader concerns regarding long-term corticosteroid toxicity, this finding suggests ongoing gaps in adherence to guideline-recommended, steroid-sparing approaches. However, the authors note that medication indication could not be determined, and prednisone use may have been prescribed for non-dermatologic conditions.

Implications for Practice

Taken together, these data support a more integrated, systems-based approach to the management of eczema and psoriasis. Routine screening for obesity and depression appears warranted in both populations, while patients with psoriasis may benefit from more proactive cardiovascular risk assessment, including evaluation of blood pressure, lipid profiles, and smoking status.

The high prevalence of depression across both conditions also underscores the need for structured mental health screening and referral pathways within dermatology practices.² Additionally, the observed corticosteroid use highlights an opportunity to reinforce guideline-based care and expand access to alternative systemic and biologic therapies when appropriate.

Limitations and Future Directions

As a cross-sectional study, the analysis cannot establish causality or temporal relationships between skin disease and comorbidities. Additionally, reliance on real-world data introduces potential variability in diagnosis and coding. The inability to determine medication indications further limits interpretation of corticosteroid use.

Despite these limitations, the large and diverse All of Us cohort provides valuable insight into real-world disease burden, particularly among populations historically underrepresented in clinical research.

Conclusion

This analysis reinforces the concept of eczema and psoriasis as systemic diseases with substantial physical and mental health burden. While psoriasis continues to demonstrate a stronger cardiometabolic risk profile, both conditions share high rates of depression, obesity, and other comorbidities. The findings highlight the importance of comprehensive, multidisciplinary care models that extend beyond skin-directed therapy to address the full spectrum of patient health.

References

1. Harikrishnan N, Chen E, Wisco O. Systemic burdens and care gaps in eczema and psoriasis: insights from the NIH all of us research program. Poster presented at: 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, Colorado. https://eposters.aad.org/s3/AM2026/poster/75276/Systemic+Burdens+and+Care+Gaps+in+Eczema+and+Psoriasis+Insights+from+the+NIH+All+of+Us+Research+Program.pdf
2. Schonmann Y, Mansfield KE, Hayes JF, et al. Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study. J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030