Metabolic Comorbidities in Pediatric Atopic Dermatitis: A Narrative Review

Abstract

Atopic dermatitis (AD) is an itchy dermatitis with multifactorial aetiology, chronic-recurrent course, and typical distribution of lesions according to the age, affecting the 10–20% of pediatric population. Patients with AD, including children, suffer from many metabolic comorbidities, including metabolic syndrome, being overweight, obesity, dyslipidaemia, and arterial hypertension, all of which had a prevalence that was demonstrated to be higher than in healthy patients. The association between AD and metabolic comorbidities is multifactorial and involves the deregulation of immune system. In fact, hypertrophic adipose tissue produces soluble adipokines involved in inflammation and immunity, which stimulate the production of pro-inflammatory cytokines, responsible for a chronic low-grade inflammatory state and a higher predisposition to hypersensitivity reactions. Especially in pediatric population with AD, these metabolic disorders are usually underestimated and are associated with long term sequelae and an increased risk of a cardiovascular event, which may also occur later in adult age. Therefore, metabolic comorbidities should be carefully evaluated and early treated in children with AD, to minimize the long-term risk of cardiovascular events.

Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases

“…The hallmark of AD is the dysfunction of the epidermal barrier, which results in loss of water and subsequent severe dryness, in turn leading to easier penetration of pathogens and allergens [ 34 ]. The clinical presentation is dependent on the age of the patient; in adults, there are erythematous and exfoliating lesions with lichenification on the flexor surfaces of limbs with accompanying severe pruritus [ 35 , 36 ]. Noteworthily, AD is a heterogenic disease, and there are significant racial differences in pathogenesis and clinical picture observed which should be taken into consideration [ 37 ].…”

“…On the contrary, there have been several studies and reviews which claim otherwise, though these were performed on smaller samples or different ethnicities, which must be noted [ 36 , 41 ]. The postulated association between AD and MS may be explained by dysregulation of the immune system.…”

“…The postulated association between AD and MS may be explained by dysregulation of the immune system. As with psoriasis, adipose tissue secrets soluble adipokines, affecting inflammatory and immune processes, which in turn stimulate the production of pro-inflammatory cytokines, which sustain the chronic inflammatory condition and provide a higher predisposition to hypersensitivity reactions [ 36 ]. Among the particular components of MS, there are reports on a positive association between AD and central obesity in both children and adults [ 36 , 41 , 42 , 43 ].…”

“…As with psoriasis, adipose tissue secrets soluble adipokines, affecting inflammatory and immune processes, which in turn stimulate the production of pro-inflammatory cytokines, which sustain the chronic inflammatory condition and provide a higher predisposition to hypersensitivity reactions [ 36 ]. Among the particular components of MS, there are reports on a positive association between AD and central obesity in both children and adults [ 36 , 41 , 42 , 43 ]. Again, similar to psoriasis, the relationship seems bidirectional; AD subjects are predisposed to obesity, and obesity enhances inflammation in AD [ 36 ].…”

“…Among the particular components of MS, there are reports on a positive association between AD and central obesity in both children and adults [ 36 , 41 , 42 , 43 ]. Again, similar to psoriasis, the relationship seems bidirectional; AD subjects are predisposed to obesity, and obesity enhances inflammation in AD [ 36 ]. As for dyslipidemia, there is evidence of its increased frequency among AD patients.…”