New research fuels greater understanding of atopic dermatitis and psoriasis in children and adolescents

For the millions of children and adolescents affected by chronic skin conditions such as atopic dermatitis and psoriasis, the toll these conditions can take on patients and their families is immeasurable. From dealing with unexpected flare ups to trying to conceal symptoms from their peers, skin disease can be an extensive source of physical and emotional pain for kids.

Now, a new understanding of skin conditions in children and teens is helping to better manage and potentially prevent medical conditions associated with both atopic dermatitis and psoriasis.

Atopic Dermatitis

Atopic dermatitis -- the most common form of eczema -- is an inflammatory skin condition characterized by chronic itchy rashes, inflammation, frequent skin infections and sleep interruptions. It is estimated that 10 to 15 percent of children in Western nations will develop atopic dermatitis in the first few years of life. Studies have established a link between atopic dermatitis and several other medical conditions that can occur in conjunction with this skin condition. This new research is aimed at better understanding this connection in children.

• Research has shown that there is an increased incidence of asthma, hay fever and food allergies in patients with atopic dermatitis. In the last few years, an abundance of new research has shown how small genetic mutations in proteins present in the epidermis (or outermost layer of the skin) create a fundamental problem in how the epidermis can function. These small mutations are very common in people with dry skin, leading researchers to believe that the mutations are responsible for dry skin and can subsequently lead to eczema.
  • These small mutations are associated with much higher rates of asthma and peanut allergies. Research suggests peanut allergies may be caused by contact with the skin rather than by eating foods containing peanuts.

• Emerging information is now pointing to certain mental health disorders associated with atopic dermatitis. Specifically, there are higher rates of attention deficit hyperactivity disorder (ADHD) in children with atopic dermatitis -- with more severe cases of this skin condition associated with a higher chance of developing ADHD. While the reason for this association is unknown, researchers are questioning whether ADHD may be caused by the sleep disturbances common in children with atopic dermatitis.

Psoriasis

Psoriasis is another chronic skin condition marked by thick, red, itchy scaly patches, affecting an estimated 7.5 million Americans. There is strong data showing psoriasis is associated with an increased risk of diabetes, cardiovascular disease and higher rates of obesity in adults.

• Emerging data from pediatric studies are investigating if there are apparent cardiovascular disease risk factors in patients with psoriasis which began during adolescence. Data currently shows higher obesity rates in children with psoriasis, as well as diabetes, lipid abnormalities, and hypertension.
• A 100-patient, case-controlled pediatric study comparing medical conditions which can occur in conjunction with psoriasis in children and those without psoriasis found that 50 percent of psoriasis patients were overweight or obese compared to 32 percent of children who did not have psoriasis.
• Another study found that a greater number of children with psoriasis had abnormal liver function tests or fasting glucose or lipid levels. Specifically, 45 percent of psoriasis patients had at least one of these risk factors of cardiovascular disease compared to less than one-third of patients without psoriasis.
• Dr. Eichenfield stressed that future research should examine the impact of inflammation over time and whether obesity is causing higher rates of psoriasis or if they are occurring together. In addition, he advised that children with psoriasis should be assessed for cardiovascular risk factors in order to try to decrease these risks in adulthood.

This information was presented at American Academy of Dermatology's Summer Academy Meeting by Lawrence F. Eichenfield, MD, FAAD, a board-certified pediatric dermatologist, chief, division of pediatric and adolescent dermatology and professor of pediatrics and medicine (dermatology), Rady Children's Hospital and University of California, San Diego School of Medicine.