Real-World Analysis of Inflammatory Dermatologic Conditions and Their Association With Keratoconus

To evaluate whether inflammatory skin conditions-including atopic dermatitis, psoriasis, seborrheic dermatitis, contact dermatitis, urticaria, and rosacea-are associated with an increased risk of keratoconus (KC).

We used data from the TriNetX Global Collaborative Network, which aggregates electronic health records from approximately 165 million patients across 19 countries. Adults aged 18 to 40 years diagnosed with each inflammatory skin condition (with no history of corneal disorders) between April 1, 2016, and August 1, 2019, were matched 1:1 with controls on demographics and known KC risk factors. Five-year KC incidence was evaluated using Kaplan-Meier and hazard ratio (HR) analyses, adjusting for potential confounders.

Compared with controls, patients with atopic dermatitis had a significantly higher 5-year risk of KC (HR = 2.32, 95% CI, 1.54-3.50), followed by psoriasis (HR = 1.93, 95% CI, 1.23-3.04), seborrheic dermatitis (HR = 1.64, 95% CI, 1.06-2.53), contact dermatitis [HR = 1.55, 95% confidence interval (CI), 1.09-2.21], and urticaria (HR = 1.56, 95% CI, 1.02-2.38). By contrast, rosacea showed no significant association with KC (HR = 0.93, 95% CI, 0.49-1.78).

In this large multicenter cohort, inflammatory skin diseases, except rosacea, were associated with increased risk of KC development. These findings underscore the potential shared inflammatory mechanisms in KC pathogenesis and highlight the importance of vigilant ocular monitoring in high-risk populations.