Adults with eczema at greater risk of accidental bone fractures, other injuries

First study to suggest eczema a risk factor for fractures and other injuries 

Intense itching and dry, irritable skin aren't the only problems adults with eczema face. They are at greater risk of accidental bone fractures and other injuries, a new Northwestern Medicine® study has found.

This is the first study to find adult eczema is a risk factor for fractures and other injuries.

The increased odds of accidental injury could be directly related to the side effects of steroids and sedating antihistamines commonly prescribed to treat the skin disorder or the under-treatment of severe cases, study authors suggest.

"Many eczema patients who are prescribed medication for itch are often given sedating antihistamines or steroids, but those medications may come at a price," said Jonathan I. Silverberg, M.D., senior author of the study. "Sedatives cause fatigue, and steroids can lead to bone density problems and osteoporosis."

Silverberg is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine and an attending physician at Northwestern Memorial Hospital.

The study, published Oct. 29 in the journal JAMA Dermatology, validates what Silverberg sees regularly at the Northwestern Multidisciplinary Eczema Center.

"Last month three of my patients with eczema cancelled at the last minute because of injuries," Silverberg said. "One fell and almost got hit by a bus, another was hit by a car and then another missed her appointment because she was in a car accident. You can't make this stuff up."

More than 10 percent of adults have eczema, which also is called atopic dermatitis. A third of those people report a moderate- to-severe form of the skin condition. The itch eczema patients experience can be maddening.

"It makes it almost impossible to function normally at work and to take care of the activities of daily living," Silverberg said. "The itch is waking patients up from their sleep at night, much in the way that chronic pain patients have difficulties sleeping."

For the study, Silverberg used data from the 2012 National Health Interview Survey, a nationally representative sample of more than 27,000 adults. Participants shared their history of fractures, bone and joint injuries and other injuries causing limitations. Those who reported a recent history with eczema (within the past 12 months) had 44 percent higher odds of all injuries, and the odds more than doubled in participants ages 30 to 49 and 50 to 69.

Many participants with eczema reported fatigue, sleeplessness or insomnia. These sleep symptoms were found to contribute to an even greater risk of accidents, compared to those with sleep symptoms and no eczema.

"Some of these patients are probably undertreated and aren't getting any relief, and they can't sleep," Silverberg said.

Doctors need to advise eczema patients to think about safety in the home and strategies to minimize falls and traumatic injuries, such as those used with other patients who have a high risk of injury, Silverberg said.

Future studies are needed to confirm the associations found in this study, but Silverberg said the results validate what he has observed for years and should be taken seriously.

"Until better options are developed to manage eczema and itch, doctors should remind patients of the side effects of their medication and encourage them to use caution when out and about and avoid situations like driving while using sedating antihistamines," he said.