Childhood Obesity Linked to Dermatologic Conditions, Associated Comorbidities

Childhood obesity is linked to an increased rate of many different dermatologic conditions and their associated comorbidities, new findings suggest, with examples of comorbidities including asthma, type 2 diabetes mellitus, and hypertension.1

These findings on dermatologic diseases and their comorbidities were the conclusion of new research by Samantha Epstein and Sonal D. Shah, MD, of Case Western Reserve University School of Medicine in Cleveland, who led this investigation. The team noted prior research demonstrating an association between obesity in adults and conditions such as hidradenitis suppurativa (HS), atopic dermatitis, psoriasis, and rosacea.2

“Despite the well-documented association in adults and children between obesity and skin conditions, few studies have evaluated these with a large sample size, while also simultaneously evaluating associated comorbidities,” Epstein and Shah wrote. “By using a population health database, this study aims to highlight the emerging public health crisis and emphasize the role of pediatric dermatologists in recognizing early dermatological signs of obesity in children.”1

Analysis of Dermatologic Conditions and Associated Comorbidities

The investigative team conducted their retrospective cohort study using the TriNetX Research Network Database to assess children under the age of 18 years with various dermatologic conditions and comorbidities. They looked at individuals both with and without obesity.

The study involved an examination of the incidence of various skin conditions within a year of obesity diagnosis. The team looked at individuals with such conditions as HS, atopic dermatitis, rosacea, skin and soft tissue infections, acne vulgaris, psoriasis, and acanthosis nigricans, comparing rates with those of children who were not living with obesity. The investigators based their identification of subjects on ICD-10-CM coding, applying propensity matching with the aim of ensuring balanced comparisons between differing cohorts.

Following propensity matching, they had a total of 515,930 children who remained as subjects in the study. Cohorts were balanced for such factors as sex, age, and race. The investigators carried out their statistical analysis via Chi-squared tests, seeking to evaluate risk difference, risk ratio, and odds ratio, setting significance at P < .05.

Overall, the research team concluded that a greater prevalence of dermatologic conditions was identified among the children in the obesity cohort. They found that acanthosis nigricans showed the greatest association and that acne vulgaris showed the lowest. The team noted that the incidence of these skin conditions indicated an increasing trend, especially among children with obesity.

In a notable finding, a rise among HS cases occurred by 17.18% in the period between 2016 - 2023, with the investigators noting comparable upward trends for other dermatologic conditions. Among children with obesity, it was observed that asthma had been the most commonly-reported comorbidity.

The analysis highlighted several different comorbidities, such as asthma, type 2 diabetes mellitus, hypertension, obstructive sleep apnea (OSA), hyperlipidemia, polycystic ovary syndrome (PCOS), major depressive disorder, attention-deficit hyperactivity disorder (ADHD), and anxiety, which the team found had been far more prevalent (P < .001) among subjects who had obesity.

Additionally, investigators found that those who were shown to both have obesity and diabetes also demonstrated a substantial risk elevation (P < .05) for all of the aforementioned skin conditions except for skin and soft tissue infections, as opposed to diabetic children who were without obesity.

Other findings suggested that children with obesity along with ADHD, hypertension, depression, or OSA were also at an elevated risk (P < .05) for all skin conditions barring rosacea when their rates were compared to children who were not living with obesity and had these comorbidities. The investigators further noted that children with obesity and PCOS faced far greater risk (P < .05) for acanthosis nigricans, HS, and infections as opposed to their counterparts with PCOS who did not have obesity.

Shah and Epstein acknowledged that possible limitations of their analysis were nonencompassing ICD codes leading to potential missed patients. Additionally, they had excluded other skin diseases from their assessment and noted that a detailed age breakdown among cohorts was not accessible.

“The increasing incidence and prevalence of skin conditions mirrors the rising rates of childhood obesity, highlighting the importance of addressing this public health issue,” they wrote.1

References

1. Epstein, S. and Shah, S.D. (2025), Evaluating the Cutaneous Manifestations and Associated Comorbidities of Childhood Obesity. Pediatric Dermatology. https://doi.org/10.1111/pde.15887.

2. T. K. Uzuncakmak, N. Akdeniz, and A. S. Karadag, “Cutaneous Manifestations of Obesity and Themetabolic Syndrome,” Clinics in Dermatology 36, no. 1 (2018): 81–88, https://doi.org/10.1016/j.clindermatol.2017.09.014.