Obese Children And Related Skin Conditions
The World Health Organization defines overweight and obesity based on the body mass index (BMI), which is calculated as weight (kg) divided by height (m2). When assessing overweight and obesity in children, it’s important to consider their age and gender. To do this, percentile curves are used, where each percentile represents a child’s rank among 100 children of the same age.
Accordingly, children are categorized as underweight if their percentile is below 5%, normal if it falls between 5% and 85%, overweight if it’s between 85% and 95%, and obese if it exceeds 95%. When evaluating overweight and obesity from a dermatological perspective, it affects various aspects of the skin, including its physiology, barrier function, sweat gland activity, sebum production, collagen structure, wound healing, subcutaneous fat tissue, lymphatic and blood circulation.
Consequently, being overweight or obese can either cause or worsen a range of skin conditions such as acanthosis nigricans, keratosis pilaris, hirsutism, skin tags, thickened skin on the soles of the feet, stretch marks, painful fat, cellulite, skin fold rashes, fungal infections, follicle inflammation, severe skin inflammation, gout, and psoriasis. Understanding the underlying mechanisms of obesity-related skin conditions is crucial for prevention and the development of more effective treatments.
While there are numerous studies on obesity-related skin issues in adults, there is a scarcity of research focused on children. Recently, we have noticed an increasing number of overweight and obese children in our clinical practice who exhibited skin problems associated with previously undiagnosed insulin resistance.
Furthermore, the researchers observed that certain skin conditions are more prevalent in individuals with darker skin tones. Consequently, the primary objective of this study was to investigate the prevalence of obesity-related skin conditions in overweight and obese children and to explore the connections between these skin conditions, insulin resistance, and skin color.
Study Overview
This study aimed to examine how common obesity-related skin conditions are among overweight children and explore the links between these skin issues, insulin resistance, and skin tone.
Methods
Children who were obese, overweight, or normal weight according to their body mass index (BMI) were included in a study. They were followed up and treated in outpatient clinics. Dermatological examinations were performed on the participants, and their fasting insulin and glucose levels were checked.
This study, which was prospective, observational, and cross-sectional in nature, aimed to explore skin conditions related to obesity in children who were either overweight or obese. The research involved overweight and obese children as well as healthy children with normal weight who received care at Kahramanmaraş Sütçü İmam University Medical Faculty Hospital between October 2016 and May 2017.
Ethical and scientific approval for the study was obtained from our local Clinical Research Ethics Committee (decision number 14, dated March 21, 2016), and the study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Only children whose families provided informed consent were included in the study. Exclusions comprised children under 2 years old or over 18 years old, children with syndromes, those with endocrine disorders unrelated to overweight and obesity, and children with a BMI below the fifth percentile.
The children’s weight and height were measured, and their BMI was calculated using the formula BMI = body weight (kg) / height (m^2). BMI percentiles were determined based on gender and age, using curves specifically designed for Turkish children. Skin type was categorized according to Fitzpatrick’s scale, which assesses skin color. Fasting plasma glucose and insulin levels were measured in the children after a 10-hour fast, and insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) equation [HOMA: fasting insulin (μU/mL) × fasting plasma glucose (mg/dL)/405]. Insulin resistance was recorded for values equal to or greater than 2.5.
Results
In a comprehensive study involving 212 children, researchers investigated dermatological conditions associated with obesity in children, with a particular focus on those who were overweight or obese. The study was conducted at Kahramanmaraş Sütçü İmam University Medical Faculty Hospital between October 2016 and May 2017, and ethical approval was obtained. The children were divided into groups based on their BMI percentiles: overweight, obese, and a control group with healthy weight. Children under 2 and over 18, those with syndromes, endocrine disorders unrelated to obesity, and BMI below the fifth percentile were excluded.
The patient group, comprising overweight and obese children, exhibited various dermatological conditions, including keratosis pilaris (KP), acne vulgaris, striae distensae, hyperhidrosis, acanthosis nigricans (AN), and more. Several of these conditions were found to be more common in the patient group than in the control group. Notably, girls with higher BMI were more likely to develop dystrophic cellulite and hirsutism.
The study also investigated the correlation between dermatoses and insulin resistance. Conditions such as KP, striae distensae, AN, hyperhidrosis, and bacterial infections were positively correlated with insulin resistance. However, dystrophic cellulite showed a positive correlation with overweight/obesity rather than insulin resistance. Seborrheic dermatitis correlated with insulin resistance, but not with overweight/obesity.
Furthermore, the researchers explored the relationship between skin color and dermatological conditions. They found that the incidence of KP, AN, and acrochordon increased with darker skin color according to the Fitzpatrick skin scale.
Logistic regression analysis revealed that higher BMI and specific skin types (Fitzpatrick skin types 3 and 4) significantly influenced the development of AN and KP. Each unit increase in BMI raised the risk of AN and KP development. Fitzpatrick skin type 3 increased the risk of AN and KP by several times compared to Fitzpatrick skin type 1.
Final Thoughts
Dermatological manifestations of obesity and insulin resistance often serve as early warning signs that precede the diagnosis of diabetes mellitus. In fact, they can be the initial indicators of an underlying metabolic disorder. Recognizing and addressing these cutaneous conditions at an early stage not only enhances the patient’s quality of life but can also potentially prevent the development of severe complications associated with insulin resistance and elevated blood sugar levels.
Conversely, the effective management of these dermatological issues is closely intertwined with the treatment of insulin resistance and obesity. A more efficient and rapid response to the treatment of skin conditions is often achieved when the root causes, such as insulin resistance and excess body weight, are effectively addressed. Understanding the underlying pathophysiology of these dermatoses is crucial in developing more potent and tailored treatment strategies.
By comprehending the intricate interplay between dermatological symptoms, obesity, and insulin resistance, healthcare professionals can provide more holistic care to their patients. Early intervention not only improves the skin health of individuals but also contributes to their overall well-being and potentially reduces the long-term consequences of metabolic disorders like diabetes mellitus.
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