Obesity is linked to disease severity in moderate to severe atopic dermatitis-Data from the prospective observational TREATgermany registry

Stephan Traidl; Moritz M Hollstein; Nadine Kroeger; Sascha Fischer; Annice Heratizadeh; Luise Heinrich; Barbara Kind; Doreen Siegels; Susanne Abraham; Thomas Schäfer; Matthias Augustin; Inken Harder; Andreas Pinter; Knut Schäkel; Andreas Wollenberg; Konstantin Ertner; Jutta Ramaker-Brunke; Anne Bong; Sven Quist; Hannah Gorriahn-Maiterth; Florian Schenck; Michael Sticherling; Isaak Effendy; Beate Schwarz; Christiane Handrick; Andrea Asmussen; Stephan Weidinger; Jochen Schmitt; Thomas Werfel; TREATgermany Study Group

doi:10.1111/jdv.20042

Obesity is linked to disease severity in moderate to severe atopic dermatitis-Data from the prospective observational TREATgermany registry

J Eur Acad Dermatol Venereol. 2025 Jan;39(1):136-144. doi: 10.1111/jdv.20042. Epub 2024 Apr 25.

Authors

Stephan Traidl¹, Moritz M Hollstein², Nadine Kroeger¹, Sascha Fischer¹, Annice Heratizadeh¹, Luise Heinrich³, Barbara Kind³, Doreen Siegels³, Susanne Abraham⁴, Thomas Schäfer⁵, Matthias Augustin⁶, Inken Harder⁷, Andreas Pinter⁸, Knut Schäkel⁹, Andreas Wollenberg^{10

11

12}, Konstantin Ertner¹³, Jutta Ramaker-Brunke¹⁴, Anne Bong¹⁵, Sven Quist¹⁶, Hannah Gorriahn-Maiterth¹⁷, Florian Schenck¹⁸, Michael Sticherling¹⁹, Isaak Effendy²⁰, Beate Schwarz²¹, Christiane Handrick²², Andrea Asmussen²³, Stephan Weidinger⁷, Jochen Schmitt³, Thomas Werfel¹; TREATgermany Study Group

Affiliations

¹ Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
² Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany.
³ Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany.
⁴ Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
⁵ Practice Dr. med. Thomas Schaefer/Dr. med. Doreen Belz, Derma Koeln, Koeln, Germany.
⁶ Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
⁷ Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
⁸ Department of Dermatology, Venereology and Allergology, Clinical Research, University Hospital, Frankfurt am Main, Germany.
⁹ Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany.
¹⁰ Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany.
¹¹ Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany.
¹² Comprehensive Center for Inflammation Medicine, University of Luebeck, Luebeck, Germany.
¹³ Practice Dr. med. Konstantin Ertner, Nuernberg, Germany.
¹⁴ Practice 'Die Hautärzte' Braunschweig, Braunschweig, Germany.
¹⁵ Practice Dr. med. Anne Bong, Emmerich, Germany.
¹⁶ Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, Germany.
¹⁷ Practice Dermasana, Karlsruhe, Germany.
¹⁸ Dermatology Center, Hannover, Germany.
¹⁹ Department of Dermatology, University, German Center for Immunotherapy, Erlangen, Germany.
²⁰ Department of Dermatology Venereology and Allergology, University Hospital - Medical School OWL - University of Bielefeld, Rosenhoehe, Bielefeld, Germany.
²¹ Practice Dr. med. Beate Schwarz, Langenau, Germany.
²² Practice Dr. med. Christiane Handrick, Berlin, Germany.
²³ Practice Dr. med. Andrea Asmussen, Dermatology at Lesum, Bremen, Germany.

Abstract

Background: There are conflicting data on a potential association between obesity and atopic dermatitis (AD). The purpose of this study was to investigate the relationship between obesity and AD disease severity.

Methods: Patients from the TREATgermany registry cohort were divided into three groups according to their body mass index (BMI). Due to low numbers, underweight patients (BMI <18.5 kg/m²) were excluded from the analysis. Physician- and patient-reported disease severity scores as well as additional phenotypic characteristics were evaluated for association with BMI. Generalized linear mixed models and multinomial logit models, respectively, were applied to investigate the association of BMI, age, sex and current systemic AD treatment with disease severity.

Results: This study encompassed 1416 patients, of which 234 (16.5%) were obese (BMI ≥30 kg/m²). Obesity was associated with lower educational background and smoking. Otherwise, obese and non-obese AD patients had similar baseline characteristics. Increased BMI was associated with higher oSCORAD (adjusted β: 1.24, 95% CI: 1.05-1.46, p = 0.013) and Patient-oriented eczema measure (POEM) (adjusted β: 1.09, 95% CI: 1.01-1.17, p = 0.038). However, the absolute difference in the overall oSCORAD was small between obese and non-obese AD patients (Δ oSCORAD = 2.5). Allergic comorbidity was comparable between all three groups, with the exception of asthma which was more pronounced in obese patients (p < 0.001).

Discussion: In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance. The overall prevalence of obesity among the German AD patients was lower than in studies on other AD cohorts from different countries, which confirms previous research on the German population and suggests regional differences in the interdependence of AD and obesity prevalence.

Publication types

Observational Study

MeSH terms

Adult
Body Mass Index*
Dermatitis, Atopic* / complications
Dermatitis, Atopic* / epidemiology
Female
Germany / epidemiology
Humans
Male
Middle Aged
Obesity* / complications
Obesity* / epidemiology
Prospective Studies
Registries*
Severity of Illness Index*

Abstract

Publication types

MeSH terms

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