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 (QoL) 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-center, cross-sectional study. All participants underwent a detailed dermatological examination, anthropometric measurements and laboratory examinations. QoL 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, homeostatic model assessment (HOMA) score 3.3 ± 4.2; mean ± s.d.) 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 QoL(QoL) 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.

Keywords: BMI; acanthosis nigricans; keratosis pilaris; quality of life; striae distensae.

Figure 1

Distribution of skin phototypes in the study population according to the Fitzpatrick scale.

Figure 2

Schematic representation of typical skin changes in children and adolescents with overweight and obesity*. *For a clear representation of skin changes, only skin type 1 is illustrated. Skin changes can occur in all skin types. External sex characteristics are not shown. All sex entities should be explicitly addressed.

Figure 3

Selection of skin changes. (A) Intertrigo; (B) abdominal striae cutis distensae; (C) axillary acanthosis nigricans; (D) nuchal acanthosis nigricans; (E) keratosis pilaris; (F) axillary acrochordons; (G) hyperkeratosis due to tight footwear.