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Review
October 20, 2021

Bullous Dermatoses and Depression: A Systematic Review

Author Affiliations
  • 1Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2University of California, Riverside, School of Medicine
  • 3Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
  • 4University of Illinois College of Medicine at Chicago
  • 5Keck School of Medicine, University of Southern California, Los Angeles
JAMA Dermatol. Published online October 20, 2021. doi:10.1001/jamadermatol.2021.4055
Key Points

Question  Are bullous dermatoses associated with high rates of depression?

Findings  This systematic review found the prevalence of depressive symptoms among patients with bullous dermatoses to range from 40% to 80%. The prevalence of depression diagnosis among patients with bullous dermatoses ranged from 11.4% to 28%.

Meaning  High rates of depression exist among patients with bullous skin disease; treating bullous skin disease may be associated with a decrease in mental health comorbidities.

Abstract

Importance  There is a lack of evidence synthesis on the association between bullous skin disease and depression.

Objective  To synthesize and interpret the current evidence on the association between bullous skin disease and depression.

Evidence Review  This review was conducted according to PRISMA guidelines and reviewed literature related to bullous skin disease and depression in the PubMed, Embase, PsycInfo, and Cochrane databases published between 1945 and February 2021. The quality of each included article was assessed via the Newcastle-Ottawa Scale. This review was registered with PROSPERO (CRD42021230750).

Findings  A total of 17 articles were identified that analyzed a total of 83 910 patients (55.2% female; specifically, 6951 patients with bullous pemphigoid, 1669 patients with pemphigus, and 79 patients with epidermolysis bullosa were analyzed). The prevalence of depressive symptoms among patients with bullous dermatoses ranged from 40% to 80%. The prevalence of depression diagnosis among patients with bullous dermatoses ranged from 11.4% to 28%.

Conclusions and Relevance  In this systematic review, high rates of depression and depressive symptoms existed among patients with bullous skin disease. Adequate treatment of bullous dermatoses may be associated with a decrease in mental health burden on patients.

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