Treating inflammatory skin disease in younger patients can be complex, particularly when it involves identifying and managing comorbidities. Atopic dermatitis (AD), the most common inflammatory skin disease in children, affects 10–20% of the pediatric population. Effective treatment requires pediatric dermatologists to carefully balance safety, efficacy, adherence, and long-term management.
The Dangers of Metabolic Comorbidities
Children with AD often experience metabolic comorbidities, including metabolic syndrome, overweight/obesity, dyslipidemia, and arterial hypertension. These associations are multifactorial, involving immune system dysregulation and the production of pro-inflammatory cytokines that contribute to chronic low-grade inflammation and increased hypersensitivity. Metabolic disorders are often underrecognized in pediatric populations but can carry long term consequences, including an increased risk of cardiovascular events in adulthood. Early evaluation and treatment of metabolic comorbidities can minimize the risk of long-term complications.
Identifying and Treating Metabolic Comorbidities
While AD is traditionally linked to other atopic conditions, emerging research has identified associations with infectious, autoimmune, respiratory, neuropsychiatric, musculoskeletal, and even cardiovascular and malignant disorders. Recognizing these comorbidities, especially in its moderate-to-severe form, supports the view of AD as a systemic disease and can help dermatologists optimize therapeutic decision making and overall clinical outcomes.
“We certainly know that, in patients with AD, these T-cell driven type 2 inflammatory diseases go hand-in-hand, particularly when there is more severe atopic skin disease,” said Amy S. Paller, MD, chair of the department of dermatology and professor of pediatrics at Northwestern University School of Medicine, Chicago, Illinois.
Researchers found that the prevalence and incidence of type 2 inflammatory diseases were higher among those patients with AD, with data showing that the overall prevalence of asthma, eosinophilic esophagitis, urticaria, and rhinitis more than doubled in pediatric patients, and was highest with severe AD.
“As new medications become available that can concurrently treat allergic disorders in addition to AD, understanding at baseline the concurrent comorbidities and tracking their improvement should be the goal,” explained Dr. Paller.
To optimize care, dermatologists should ask parents about signs of these atopic comorbidities and implement a multidisciplinary approach with dermatologists collaborating closely with allergists and immunologists.
Mental Health, Obesity, and Metabolic Considerations
Hidradenitis suppurativa (HS), the chronic inflammatory skin condition characterized by painful, inflamed nodules and abscesses, can lead to significant physical discomfort and emotional distress. A recent meta-analysis of 19 studies found that pediatric patients with HS show an increased rate of medical and psychiatric comorbidities, including inflammatory bowel disease, mental health disorders, and obesity.
The most prevalent condition in patients with HS was acne vulgaris (43%), followed by obesity (37%), anxiety (18%), and hirsutism (14%). Researchers also found a probable association between depression and HS (moderate certainty), with all studies reporting a higher incidence among patients with HS, as well as an association with diabetes in three studies (low certainty).
Multidisciplinary Care Models
Topical therapy represents the frontline treatment of AD, both in acute phases and maintenance. When the disease becomes severe, the switch to systemic therapy with immunosuppressive agents and/or biologic drugs may be required.
Recent updates to labeling for a number of anti-inflammatory treatments for dermatologic diseases now include adolescents and children, and this trend is expected to continue. For example, in pediatric psoriasis, the oral IL-23 inhibitor, icotrokinra, is anticipated to be a “game changer” for adolescent patients if approval proceeds in 2026, according to Lawrence Eichenfield, MD, professor of dermatology and pediatrics at UC San Diego and chief of pediatric dermatology at Rady Children’s Hospital.
Conclusion
Treating pediatric inflammatory skin disease often requires identifying and managing comorbidities. Though challenging, this approach is essential for supporting overall health, preventing long-term complications, and improving patient outcomes. Collaboration with parents, caregivers, and multidisciplinary specialists is key to delivering comprehensive care for young patients with complex dermatologic conditions.
Sources:
- Metabolic Comorbidities in Pediatric Atopic Dermatitis: A Narrative Review
- An Overview of Pediatric Psoriasis
- Comorbidities Associated with Atopic Dermatitis
- Pediatric HS Linked to Obesity, Acne, Other Comorbidities in Meta-analysis
- More Systemic Therapies Coming for Pediatric Skin Diseases
- Study Documents Benefits of Multidisciplinary Pediatric AD Clinic
- Pediatric Patients with Atopic Dermatitis Have an Increased Risk of Type 2 Inflammatory Diseases
- Challenges in treating pediatric skin conditions
