Obese children present with more inflammatory conditions

Obesity is certainly not a public health issue confined to adults, and the rise in obesity in children has shown an impact on dermatological conditions, according to Paradi Mirmirani, M.D., assistant clinical professor in the department of dermatology at the University of California at San Francisco, San Francisco. She is a general dermatologist at Kaiser Permanente Northern California Managed Healthcare System in Vallejo, Calif.

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"The (excess) adipose tissue is having a large effect on the skin (in children)," Dr. Mirmirani told Dermatology Times, noting she was prompted to examine skin disorders in obese children because the subject has not been explored in the literature. She recently published findings based on a retrospective, population-based study of pediatric patients that found, amongst other conclusions, that a greater proportion of insulin resistance disorders, bacterial infection, fungal infection, inflammatory disorders, mechanical changes, like stretch marks and other skin conditions were present in obese subjects compared with normal weight patients.¹ 

It is estimated that one in six children in the US (16.4 percent) are obese, and 31.6 percent are overweight.²

Dr. Mirmirani used the Centers for Disease Control and Prevention criteria to define obesity in children: Children with a body mass index in the 95th percentile or greater were defined as obese, those overweight were defined as the 85th to 95th percentile, and normal BMI is considered less than the 85th percentile.

Interestingly, Dr. Mirmirani did not find that conditions linked to androgen excess, such as acne, or viral infections, such as warts and molluscum, were elevated in obese children. On the contrary, these conditions were significantly less common in obese children.     

"We hypothesized that the inflammatory signal associated with excess body fat counteracted other factors leading to viral infections or things like acne," Dr. Mirmirani explains. "It is a possibility that some of the inflammatory signals decreased susceptibility to viral infections."

Despite greater prevalence of inflammatory conditions in obese children and greater prevalence of bacterial and fungal infections in obese children, the study found obese children were less likely than their normal weight counterparts to have a dermatology encounter.

The association between pediatric obesity and cutaneous disorders linked to inflammation and the link between pediatric obesity and bacterial and fungal infections underline the need for dermatologists to communicate the value of behavioural modification, Dr. Mirmirani says.

"If you think about the lifetime burden of disease, there will be more of a burden (if children continue to be obese in adulthood)," Dr. Mirmirani says. "If we can intervene early on through include counselling about healthy eating, activity and weight loss, that will have a big impact."

Dr. Mirmirani had no relevant disclosures.

1 Mirmirani P, Carpenter DM. Skin disorders associated with obesity in children and adolescents: a population-based study. Pediatr Dermatol. 2014;31(2):183-90.

2 Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA. 2008;299(20):2401-5.