risk of heart disease, stroke and diabetes.
Early childhood obesity has been associated with atopic dermatitis development
and severity. In psoriasis, increased abdominal girth and obesity may precede
disease by a few years, suggesting their
role as triggers in disease. One interesting
feature of psoriatic disease is promising
data from adults who had weight loss
surgery and experienced psoriatic disease
Despite many common comorbidities,
pediatric atopic dermatitis and pediatric
psoriasis have many distinctive features.
In atopic dermatitis, the skin barrier is
both weak and weakened by inflammation, allowing a series of unusual allergic features, i.e., the atopic march and infectious
complications. Alternatively, in psoriasis the skin
is triggered to thicken, and the joints may become
Further divergence is seen in the clinical manifes-
tations. In psoriasis, arthritis is the leading comor-
bidity, sometimes triggered by streptococcal disease.
There also is a far more definitive association with
metabolic syndrome features such as hypertension,
hyperlipidemia and insulin resistance. Despite the
common nature of psoriasis and the frequency of
disease, atopic dermatitis has developed a more
extensive laundry list of comorbidities, including
infantile seborrheic dermatitis, Malassezia sensiti-
zation, dust allergy, asthma, food allergy, environ-
mental allergens, contact dermatitis (e.g., lanolin,
fragrance), prurigo, sleep disturbance, upper respira-
tory infections, warts, coxsackie generalization (e.g.,
eczema coxsackium) and cataracts.
The development of screening tools and inter-
ventions for pediatric patients with inflammatory
skin disease is a work in progress. It is becoming
clear that physicians treating patients of any age,
including children, need to consider screening for
comorbidities of disease, especially features of met-
abolic syndrome, obesity and psychological issues.
Children with atopic dermatitis should be further
screened for sleep disturbance and psoriatic children
While it is not known how interventions will impact skin disease, they may improve overall long-term health of children with inflammatory skin
Dr. Silverberg is a member of the AAP Section on
Committee, and Dr. Jacob is a member of the
section. Dr. Silverberg Dr. Jacob
Image courtesy of the Centers for Disease Control and Prevention
One of the possible comorbidities of atopic dermatitis is the
genetic skin disorder ichthyosis vulgaris (above), which is characterized by dry, crackling, scaling skin.