Pediatric obesity and skin disease: cutaneous findings and associated quality-of-life impairments in 103 children and adolescents with obesity

Abstract

Objective: Little is known about specific cutaneous findings in children and adolescents with overweight and obesity. This study assessed the association of skin signs with pivotal auxological and endocrinological parameters and their influence on the quality of life of young people with obesity. Study design: All patients initially recruited for a tertiary hospital's weight control program were offered participation in this interdisciplinary, single-centre, cross-sectional study. All participants underwent a detailed dermatological examination, anthropometric measurements and laboratory examinations. Quality of life was assessed with validated questionnaires. Results: A total of 103 children and adolescents (age 11.6 ±2.5 years, 41% female, 25% prepubertal, BMI SDS 2.6 ±0.5, HOMA score 3.3 ±4.2; mean ± SD) were recruited in a 12-month study period. Skin affections were linearly associated with increasing BMI and higher age. The most common skin findings were [%] striae distensae (71.0), keratosis pilaris (64.7), acanthosis nigricans (45.0), acne vulgaris (39.2), acrochordons (25.5) and plantar hyperkeratosis (17.6). The HOMA score was associated with acanthosis nigricans (p=0.047), keratosis pilaris (p=0.019) and acne vulgaris (p<0.001). The general mean quality of life score, as assessed by the WHO-5, was 70 out of 100. A total of 38.9% of participants reported impaired dermatological QoL. Conclusions: This study shows the high prevalence of skin lesions in children and adolescents with obesity. The association between skin lesions and the HOMA score indicates that skin manifestations are a marker of insulin resistance. To prevent secondary diseases and improve QoL, thorough skin examinations and interdisciplinary cooperation are necessary.

Not Only Metabolic Complications of Childhood Obesity

“…Thus, it may contribute to the increased incidence of cutaneous manifestations and disorders, such as acanthosis nigricans, hirsutism, striae distensae, acrochordons, keratosis pilaris, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, psoriasis, skin infections, and hidradenitis suppurativa [ 213 ]. Numerous studies regarding the link between obesity and dermatological diseases among adults can be found in the literature; however, evidence for the pediatric population is scarce [ 214 ]. Nevertheless, a recent study of 103 children and adolescents with excessive body weight showed a high incidence of skin abnormalities occurring in this group [ 214 ].…”

“…Numerous studies regarding the link between obesity and dermatological diseases among adults can be found in the literature; however, evidence for the pediatric population is scarce [ 214 ]. Nevertheless, a recent study of 103 children and adolescents with excessive body weight showed a high incidence of skin abnormalities occurring in this group [ 214 ]. Skin alterations were associated with increasing BMI and age, and the most prevalent were striae distensae (71%), keratosis pilaris (64.7%), acanthosis nigricans (45%), acne vulgaris (39.2%), acrochordons (25.5%), and plantar hyperkeratosis (17.6%) [ 214 ].…”

“…Nevertheless, a recent study of 103 children and adolescents with excessive body weight showed a high incidence of skin abnormalities occurring in this group [ 214 ]. Skin alterations were associated with increasing BMI and age, and the most prevalent were striae distensae (71%), keratosis pilaris (64.7%), acanthosis nigricans (45%), acne vulgaris (39.2%), acrochordons (25.5%), and plantar hyperkeratosis (17.6%) [ 214 ]. In addition, 38.9% of subjects showed reduced dermatological quality of life [ 214 ].…”

“…Skin alterations were associated with increasing BMI and age, and the most prevalent were striae distensae (71%), keratosis pilaris (64.7%), acanthosis nigricans (45%), acne vulgaris (39.2%), acrochordons (25.5%), and plantar hyperkeratosis (17.6%) [ 214 ]. In addition, 38.9% of subjects showed reduced dermatological quality of life [ 214 ]. Striae distensae are also the most frequently observed dermatologic condition among children with obesity, according to the study by Güven et al [ 215 ].…”

“…Moreover, the presence of acanthosis nigricans, keratosis pilaris, and acne vulgaris is associated with increased HOMA-IR (an index of insulin resistance) among children and adolescents with obesity, which may suggest a role for skin lesions as a potential marker of insulin resistance [ 214 ]. Insulin resistance has been shown to promote proliferation of fibroblasts and keratinocytes by insulin, insulin-like growth factor receptor-1 (IGFR1), and fibroblast and epidermal growth factors, resulting in the development of acanthosis nigricans [ 220 ].…”