Eczema wreaks havoc on its sufferers’ lives with health problems that are more than skin deep. Adults who have eczema—a chronic itchy skin disease that often starts in childhood—have higher rates of smoking, drinking alcoholic beverages, and obesity and are less likely to exercise than adults who don’t have the disease, reports a new Northwestern Medicine study.

These behaviors give them a higher risk of cardiovascular disease, including high blood pressure and high cholesterol as well as diabetes. They also have higher rates of insomnia. About 10% of adults in the United States have eczema.

“This disease takes a huge emotional toll on its sufferers, like chronic pain,” says lead study author Dr Jonathan Silverberg, in a releas. “Because eczema often starts in early childhood, people are affected all through their developmental years and adolescence. It hurts their self-esteem and identity. That’s part of why we see all these negative behaviors.”

Silverberg is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine and a dermatologist at Northwestern Memorial Hospital. He also is director of the Northwestern Medicine Multidisciplinary Eczema Center.

Adding to eczema patients’ health woes is difficulty exercising because sweat and heat aggravate the itching. “They will avoid anything that triggers the itch,” Silverberg says. “Patients report their eczema flares during a workout.”

The study was published January 8 in the Journal of Allergy and Clinical Immunology.

“This opens our eyes in the world of dermatology that we’re not just treating chronic inflammation of the skin but the behavioral, lifestyle side of things,” Silverberg says. Dermatologists need to ask patients about their lifestyle habits such as smoking and physical activity so they can offer interventions.

The study analyzed data for 27,157 and 34,525 adults aged 18 to 85 years from the 2010 and 2012 National Health Interview Survey. The Northwestern study reported patients with eczema had 54% higher odds of being morbidly obese, 48% higher odds of hypertension, up to 93% higher odds of having prediabetes, and up to 42% higher odds of having diabetes. They also had 36% higher odds of high cholesterol.

The paper says, “There were significant interactions between eczema and sleep disturbances such that eczema associated with fatigue, daytime sleepiness, or insomnia was associated with even higher odds of obesity, hypertension, hypertension on 2 visits, prediabetes, diabetes, and high cholesterol than eczema alone.”

Silverberg says patients should be offered interventions for alcohol and smoking by their dermatologists. In addition, he is collaborating with colleagues in Northwestern’s department of physical therapy and human movement sciences to figure out how patients with eczema can exercise to improve their health without worsening their skin flare-ups.