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The Morbid Facts of Skin Co-Morbidities


After attending the American Academy of Dermatology’s (AAD) Summer Meeting this summer, the overwhelming takeaway for me was that the skin health industry is larger and more diverse than ever. Given the many conversations and presentations at the conference surrounding co-morbidities, the industry is poised for exponential growth and greater discovery for other disease states. This emerging focus represents a convergence of many areas of medicine with skin health (and those who invest in it) positioned to take a significant role.


Let’s look at psoriasis – while commonly viewed as simply an uncomfortable and annoying condition, studies have shown that psoriasis has a direct correlation to cardiovascular conditions, diabetes and obesity. Patients have also demonstrated mental health issues stemming from psoriasis outbreaks, reporting symptoms of depression and anxiety as a result of dealing with the sometimes painful skin disease. As Dr. Bruce Strober discussed at the conference, 18% of psoriasis patients have depression, 18% have Type 2 diabetes and 14% are obese. Rather than viewing these diseases as mutually exclusive, there is great opportunity to address the whole patient and how these various afflictions are impacting and perhaps exacerbating one another.


Similarly, patients suffering from atopic dermatitis (AD) report high incidences of co-morbidities. As the most common inflammatory skin disease, AD impacts countless patients and studies have demonstrated that patients with a family history of allergic disease often suffer from other atopic diseases such as allergic rhinitis and asthma, together commonly referred to as “atopic march.” Infections are also common among AD patients — Staphylococcus aureus was found on 90% of the affected skin areas, leading some to suggest that a vaccine for the infection could perhaps also treat AD. Researchers believe that the compromised skin barrier in patients with AD leads to higher incidence of these secondary conditions, understandably.


Hidradenitis suppurativa (HS), which presents as small to large bumps under the skin as a result of excess sweat and inflammation, was also discussed at the conference relative to the many co-morbidities associated with this disease. Dr. Amit Garg presented data that found HS patients are at a higher risk to develop anxiety (36%), depression (35.8%), and obesity (35.1%). Much like psoriasis patients, HS patients also have an elevated incidence of cardiovascular incidents such as heart attack and stroke (20%), compared with patients without HS. Type 2 diabetes is similarly common among HS patients—25% of HS sufferers are also diabetes patients. Lastly, patients with HS are three times more likely to have Crohn’s disease.


In each of these diseases, the high occurrence of co-morbidities opens up the opportunity to research disease pathways and alternative treatments with the ultimate goal of treating the underlying condition, not just the symptoms. Moreover, while there is copious research confirming the correlation between these diseases, it's important that we develop targeted treatments that would address the skin disease and its co-morbidities. Skin, as our largest organ and the envelope through which we interact with the world, is the ideal entry point for this wholistic view of treatment of multiple co-morbidities.


We at Gore Range believe this represents a tremendous opportunity for the future of skin health and those who invest in its ecosystem.

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Ethan Rigel, Managing Partner