Depression and Serum Content of Serotonin in Adult Patients with Atopic Dermatitis

  • Andrzej Kazimierz JaworekEmail author
  • Magdalena Jaworek
  • Marta Makara-Studzińska
  • Krystyna Szafraniec
  • Zbigniew Doniec
  • Jacek Szepietowski
  • Anna Wojas-Pelc
  • Mieczyslaw Pokorski
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1271)


Atopic dermatitis (AD) is a chronic skin disease with the etiology not yet conclusively established. Recent reports demonstrate the role of serotonin (5-hydroxytryptamine; 5-HT) in the pathogenesis of AD. The aim of this study was to investigate the relationship between the serum content of serotonin and depression in adult patients suffering from severe AD. There were 31 patients of the median age of 41 years enrolled into the study, who suffered from AD since childhood, and a control group that consisted of 14 healthy subjects. AD was diagnosed on the basis of Hanifin and Rajka criteria. The severity of skin lesions was assessed with the SCORing Atopic Dermatitis (SCORAD) index and that of depression with the Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire. We found that all of the patients with severe AD characterized by SCORAD >50 had depression. Depression was classified as mild and moderate according to the MADRS score. Serotonin content was significantly lower in the patients with severe AD (MADRS >12), and there was an adverse relation between the serotonin content and the score of depression, the features not noticed in the control group. We conclude that severe AD, as expressed by the intensification of skin lesions, associates with depression and with the lowering of serum serotonin content. The findings point attention to the cognitive and affective problems in AD patients which could worsen the course of the skin disease.


Affective symptoms Atopic dermatitis Depression Serotonin Skin lesions 


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Medical College of the Jagiellonian University in Cracow, Poland.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, Margolis DJ, de Bruin-Weller M, Eckert L (2018) Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 73:1284–1293CrossRefGoogle Scholar
  2. Brunner PM, Silverberg JI, Guttman-Yassky E, Paller AS, Kabashima K, Amagai M, Luger TA, Deleuran M, Werfel T, Eyerich K, Stingl G, Councilors of the International Eczema Council (2017) Increasing comorbidities suggest that atopic dermatitis is a systemic disorder. J Invest Dermatol 137(1):18–25CrossRefGoogle Scholar
  3. Carhart-Harris RL, Nutt DJ (2017) Serotonin and brain function: a tale of two receptors. J Psychopharmacol 3:1091–1120CrossRefGoogle Scholar
  4. Cheng CM, Hsu JW, Huang KL, Bai YM, Su TP, Li CT, Yang AC, Chang WH, Chen TJ, Tsai SJ, Chen MH (2015) Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord 178:60–65CrossRefGoogle Scholar
  5. Chrostowska-Plak D, Reich A, Szepietowski JC (2013) Relationship between itch and psychological status of patients with atopic dermatitis. J Eur Acad Dermatol Venereol 27(2):e239–e242CrossRefGoogle Scholar
  6. Eskeland S, Halvorsen JA, Tanum L (2017) Antidepressants have anti-inflammatory effects that may be relevant to dermatology: a systematic review. Acta Derm Venereol 97:897–905CrossRefGoogle Scholar
  7. Gałecki P, Talarowska M (2018) Inflammatory theory of depression. Psychiatr Pol 52:437–447CrossRefGoogle Scholar
  8. Hanifin JM, Rajka G (1980) Diagnostic features of atopic dermatitis. Acta Dermatol Venerol (Stockh) 92(Suppl):44–47Google Scholar
  9. Herr N, Bode C, Duerschmied D (2017) The effects of serotonin in immune cells. Front Cardiovasc Med 4:48CrossRefGoogle Scholar
  10. Hosogi M, Schmelz M, Miyachi Y, Ikoma A (2006) Bradykinin is a potent pruritogen in atopic dermatitis: a switch from pain to itch. Pain 126(1–3):16–23CrossRefGoogle Scholar
  11. Katoh N, Soga E, Nara T, Tamagawa-Mineoka R, Nin M, Kotani H, Masuda K, Kishimoto S (2006) Effect of serotonin on the differentiation of human monocytes into dendritic cells. Clin Exp Immunol 146(2):354–361CrossRefGoogle Scholar
  12. Kawana S, Kato Y, Omi T (2010) Efficacy of a 5-HT1a receptor agonist in atopic dermatitis. Clin Exp Dermatol 35:835–840CrossRefGoogle Scholar
  13. Kim K (2012) Neuroimmunological mechanism of pruritus in atopic dermatitis focused on the role of serotonin. Biomol Ther (Seoul) 20:506–512CrossRefGoogle Scholar
  14. Kritas SK, Saggini A, Cerulli G, Caraffa A, Antinolfi P, Pantalone A, Rosati M, Tei M, Speziali A, Saggini R, Conti P (2014) Relationship between serotonin and mast cells: inhibitory effect of anti-serotonin. J Biol Regul Homeost Agents 28(3):377–380PubMedGoogle Scholar
  15. Leung DY, Guttman-Yassky E (2014) Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. J Allergy Clin Immunol 134(4):769–779CrossRefGoogle Scholar
  16. Lonne-Rahm SB, Rickberg H, El-Nour H, Mårin P, Azmitia EC, Nordlind K (2008) Neuroimmune mechanisms in patients with atopic dermatitis during chronic stress. J Eur Acad Dermatol Venereol 22(1):11–18CrossRefGoogle Scholar
  17. Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389CrossRefGoogle Scholar
  18. Nowicki R, Trzeciak M, Wilkowska A, Sokołowska-Wojdyło M, Ługowska-Umer H, Barańska-Rybak W, Kaczmarski M, Kowalewski C, Kruszewski J, Maj J, Silny W, Śpiewak R, Petranyuk A (2015) Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology. Adv Dermatol Allergol 32(4):239–249CrossRefGoogle Scholar
  19. Rasul A, Nordlind K, Wahlgren CF (2013) Pruritic and vascular responses induced by serotonin in patients with atopic dermatitis and in healthy controls. Acta Derm Venereol 93:277–280CrossRefGoogle Scholar
  20. Rasul A, El-Nour H, Lonne-Rahm SB, Fransson O, Johansson C, Johansson B, Zubeidi M, Seeberg E, Djurfeldt DR, Azmitia EC, Nordlind K (2016) Serotonergic markers in atopic dermatitis. Acta Derm Venereol 96(6):732–736PubMedGoogle Scholar
  21. SCORAD (1993) Severity scoring of atopic dermatitis: the SCORAD index. Consensus report of the European task force on atopic dermatitis. Dermatology 186(1):23–31CrossRefGoogle Scholar
  22. Soga F, Katoh N, Inoue T, Kishimoto S (2007) Serotonin activates human monocytes and prevents apoptosis. J Invest Dermatol 127(8):1947–1955CrossRefGoogle Scholar
  23. Ständer S, Böckenholt B, Schürmeyer-Horst F, Weishaupt C, Heuft G, Luger TA, Schneider G (2009) Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol 89(1):45–51CrossRefGoogle Scholar
  24. Sybilski AJ, Raciborski F, Lipiec A, Tomaszewska A, Lusawa A, Samel-Kowalik P, Walkiewicz A, Krzych E, Komorowski J, Samolińsk B (2015) Atopic dermatitis is a serious health problem in Poland. Epidemiology studies based on the ECAP study. Postepy Dermatol Alergol 32(1):1–10PubMedPubMedCentralGoogle Scholar
  25. Timonen M, Hakko H, Miettunen J, Karvonen JT, Herva A, Räsänen P, Koskinen O, Zitting P (2001) Association between atopic disorders and depression: findings from the northern Finland 1966 birth cohort study. Am J Med Genet 105(2):216–217CrossRefGoogle Scholar
  26. Vinnik T, Kirby M, Bairachnaya M, Koman I, Tarkina T, Sadykova G, Abildinova G, Batpenova G, Pinhasov A (2017) Seasonality and BDNF polymorphism influences depression outcome in patients with atopic dermatitis and psoriasis. World J Biol Psychiatry 18(8):604–614CrossRefGoogle Scholar
  27. Wei HT, Lan WH, Hsu JW, Huang KL, Su TP, Li CT, Lin WC, Chen TJ, Bai YM, Chen MH (2016) Risk of developing major depression and bipolar disorder among adolescents with atopic diseases: a nationwide longitudinal study in Taiwan. J Affect Disord 203:221–226CrossRefGoogle Scholar
  28. Weidinger S, Novak N (2016) Atopic dermatitis. Lancet 387(10023):1109–1122CrossRefGoogle Scholar
  29. Wollenberg A, Barbarot S, Bieber T et al (2018) Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 32(6):850–878CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Andrzej Kazimierz Jaworek
    • 1
    Email author
  • Magdalena Jaworek
    • 2
  • Marta Makara-Studzińska
    • 3
  • Krystyna Szafraniec
    • 4
  • Zbigniew Doniec
    • 5
  • Jacek Szepietowski
    • 6
  • Anna Wojas-Pelc
    • 1
  • Mieczyslaw Pokorski
    • 7
  1. 1.Department of DermatologyJagiellonian University Medical CollegeCracowPoland
  2. 2.Department of Physiotherapy, Faculty of Health SciencesJagiellonian University Medical CollegeCracowPoland
  3. 3.Department of Health Psychology, Faculty of Health SciencesJagiellonian University Medical CollegeCracowPoland
  4. 4.Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health SciencesJagiellonian University Medical CollegeCracowPoland
  5. 5.Department of Pneumology, Institute of Tuberculosis and Lung DisordersField Unit in RabkaRabkaPoland
  6. 6.Department of Dermatology, Venereology and AllergologyWroclaw Medical UniversityWroclawPoland
  7. 7.Department of PhysiotherapyOpole Medical SchoolOpolePoland

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