Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(4):5766 1 Treatment Strategies for Atopic Dermatitis in Adults Who Exhibit Non-Allergic Comorbidities꞉ Real-Life Data from a Tertiary Greek Hospital Εleni Paschou1, Αimilios Lallas1, Katerina Bakirtzi1, Dimitra Kiritsi1,2, Efstratios Vakirlis1, Eleni Sotiriou1 1 First Department of Dermatology and Venereology, School of Medicine, Aristotle University of Thessaloniki 2 Department of Dermatology, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany Key words: Atopic Dermatitis, Comorbidities, Treatment, Real life Citation: Paschou E, Lallas A, Bakirtzi K, Kiritsi D, Vakirlis E, Sotiriou E. Treatment Strategies for Atopic Dermatitis in Adults Who Exhibit Non-Allergic Comorbidities꞉ Real-Life Data from a Tertiary Greek Hospital. Dermatol Pract Concept. 2025;15(4):5766. DOI: https://doi. org/10.5826/dpc.1504a5766 Accepted: Sptember 8, 2025; Published: October 2025 Copyright: ©2025 Paschou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Dr Paschou Eleni, First Department of Dermatology and Venereology, School of Medicine, Aristotle University of Thessaloniki, 124 Delfon, 54643, Thessaloniki, Greece. ORCID ID:0009-0005-7478-6856. Email: eipaschou@auth.gr Introduction Atopic dermatitis (AD) is the most common chronic inflam- matory skin disease characterized by relapsing eczema with intense pruritus, which greatly impacts patients’ quality of life [1].While associations between AD and allergic con- ditions have been recognized for decades, numerous non- allergic comorbidities have also been identified [2].However, treatment guidelines lack high-quality evidence regarding therapeutic algorithms which consider these associations [3]. This study presents real-life treatment data for selected AD comorbidities. Findings A retrospective observational study was conducted at the First Department of Dermatology and Venereology of Aristotle University, Greece from April 2022 to May 2024 in compliance with the Declaration of Helsinki. This study was approved by the Bioethics Committee (Registry num- ber: 3.651/18.01.2022). Written informed consent was ob- tained from adult participants (≥18 years) with clinically diagnosed moderate-to-severe AD according to Hanifin and Rajka criteria who had at least one non-allergic comorbid- ity and complete electronic medical records available for the study period. Non-qualifying patients were excluded. Data were available for 50 patients, 27 (54.0%) males and 23 (46.0%) females, with a mean age of 39 years. Patients were grouped according to their comorbid condition. The first group consisted of those who exhibited metabolic and car- diovascular diseases (CVD), 28 patients (56.0%) (obesity N=10, dyslipidemia N=5, type 2 diabetes N=2, hyperten- sion N=6, peripheral and coronary artery disease N=3, deep vein thrombosis N=1, atrial fibrillation N=1). The second 2 Research Letter | Dermatol Pract Concept. 2025;15(4):5766 group had immune-related disorders: 19 patients (38.0%) (alopecia areata N= 8, vitiligo N=2, chronic urticaria N=2, rheumatoid arthritis N=4, systemic lupus erythematosus N=1, psoriasis N=1, inflammatory bowel disease N=1), and the third had bone health conditions: three patients (6.0%) (osteoporosis N=2, osteoporotic bone fractures N=1). Treatment decisions were made using SCORAD (Scoring Atopic Dermatitis), EASI (Eczema Area and Severity Index), and IGA (Investigator’s Global Assessment scale) scoring systems, considering age, sex, and comorbidities through multidisciplinary consultation when appropriate. For moderate-to-severe disease, phototherapy, predominantly narrowband UVB, and less frequently UVA1, administered three times per week for six months, was the most com- monly used treatment in CVD patients. For relapsing dis- ease, dupilumab was chosen due to its safety profile. For immune-mediated disorders, biologics and small molecules were prescribed more frequently. In the bone health group, systemic corticosteroids and cyclosporine were excluded due to negative bone effects. Targeted therapies were ini- tiated more frequently. Systematic agents are summarized in Table 1. All treatments were combined with topical mild-to-moderate corticosteroids. No serious adverse event was identified during the 26-month follow-up. Conclusion Our findings align with recent epidemiological studies demonstrating high prevalence of CVD and autoimmune comorbidities in AD patients, reflecting AD’s systemic in- flammatory nature [4]. Dermatologists’ choices in our study are greatly dependent on disease activity and comorbid con- ditions. While international recommendations emphasize systemic immunosuppression for severe AD, our real-world data show a cautious, personalized approach in CVD pa- tients. The predominant use of phototherapy reflects safety considerations in clinical practice. The use of JAK inhibitors for autoimmune conditions in our cohort is consistent with recommendations [5]. Our preference for dupilumab across all comorbidity groups aligns with real-world effectiveness studies regarding cardiovascular safety [6]. Future studies are needed to establish evidence-based treatment algorithms for AD patients with specific comorbidity profiles. Ethical Approval: This study was approved by the Bioethics Committee of the Medical School of Aristotle University of Thessaloniki, Greece (Registry number: 3.651/18.01.2022). The research process complied with the Declaration of Hel- sinki. Written informed consent was obtained from all patients. Table 1. Treatment Choices for Patients Exhibiting Non-Allergic Comorbidities. Treatment Dose Metabolic and cardiovascular comorbidities Immune-mediated comorbidities Osteoporosis Percentage %a (N)b Percentage % (N) Percentage % (N) Phototherapy NB-UVBc 2 or 3 times per week 57.1% (16) UVA1d 2 or 3 times per week 17.8% (5) Systemics Corticosteroids 0.35-1 mg/kg per day 10.5% (2) Cyclosporine (CyA) 2.5-5 mg/kg per day 3.6% (1) 21.1% (4) Methotrexate (MTX) 5-15 mg per week 3.6% (1) Azathioprine (AZA) 1-3 mg/kg per day 5.3% (1) Dupilumab 600 mg s.c day 1 followed by 300 mg Q2W 17.9% (5) 10.5% (2) 66.7% (2) Baricitinib 4 mg or 2mg per day 26.3% (5) Upadacitinib 30 mg or 15 mg per day 26.3% (5) Abrocitinib 200 mg or 100 mg per day 33.3% (1) a. Percentage (%): percentage of patients receiving this treatment from each group; b. (N): number of patients receiving this treatment.; c. NB-UVB: narrow-band ultraviolet B.; d. UVA1: ultraviolet A1. Research Letter | Dermatol Pract Concept. 2025;15(4):5766 3 References 1. Silverberg JI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017; 35(3):283–289. DOI: 10.1016 /j.det.2017.02.002. PMID: 28577797 2. Thyssen JP, Halling A, Schmid-Grendelmeier P, Guttman-Yassky E, Silverberg JI. Comorbidities of atopic dermatitis—what does the evidence say? J Allergy Clin Immunol. 2023;151(5): 1155-1162. DOI: 10.1016/j.jaci.2022.12.002. PMID: 36621338 3. Wollenberg A, Kinberger M, Arents B, et al. European guideline (EuroGuiDerm) on atopic eczema: part I – systemic therapy. J Eur Acad Dermatol Venereol. 2022;36(9):1409-1431. DOI: 10.1111/jdv.18345. PMID: 35980214 4. Silverberg, J. I., Gelfand, J. M., Margolis, D. J., et al. Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults. Ann Allergy Asthma Immunol 2018 Nov;121(5): 604612.e3. DOI: 10.1016/j.anai.2018.07.042. PMID: 30092266 5. Mikhaylov D, Ungar B, Renert-Yuval Y, Guttman-Yassky E. Oral Janus kinase inhibitors for atopic dermatitis. Ann Allergy Asthma Immunol. 2023;130(5):577-592. DOI: 10.1016/j.anai .2023.01.031. PMID: 37137601. 6. Simpson, E. L., Bieber, T., Guttman-Yassky, E., et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. New England Journal of Medicine. 2016 Dec 15;375(24): 2335-2348. DOI:10.1056/NEJMoa1610020. PMID: 27690741