Obesity and elevated blood pressure associated with pediatric atopic dermatitis

1. Pediatric patients with moderate to severe atopic dermatitis (AD) were more likely to have an elevated body-mass index (BMI) for their age and sex reference range than patients without the disease.

2. Severe AD in pediatric patients was associated with elevated systolic blood pressure.

Evidence Rating Level: 2 (Good)

Study Rundown: Atopic dermatitis is a chronic inflammatory skin disease characterized by pruritus and increased morbidity. Previous studies have suggested an association between obesity and inflammatory skin disorders, namely psoriasis. Authors of this study sought to investigate whether pediatric AD patients had high rates of central obesity and elevated blood pressure (BP). Results showed that severe AD was associated with (1) higher BP for age and sex percentiles, (2) age and sex-matched BMI ≥97^th percentile, and (3) waist circumference ≥85^th percentile. The study’s strengths were its prospective study design and the varied metrics used to assess adiposity. Its limitations were that measured BP was based on a single reading, the healthy control arm had a statistically significant difference in median age as compared to the AD arm, and that all potential confounders may not have been controlled for including duration of topical and systemic treatments.

Click to read the study in JAMA Dermatology      

Relevant Reading: Obesity is associated with increased atopic dermatitis in adulthood

In-Depth [case-control study]: In this multi-center study, 132 pediatric patients aged 4-17 were recruited with moderate to severe AD as diagnosed by a dermatologist and compared with 143 control patients without the disease that were race/ethnicity and sex-matched. Patients with AD were significantly younger and shorter than controls (P=.03 and P=.01, respectively). Moderate-to-severe AD was associated with BMI ≥97^th percentile with an odds ratio (OR) of 2.64; 95% CI, 1.15-6.06. Both univariate and multivariate analysis showed an association between central obesity as measured by both waist circumference ≥85 percentile (OR, 3.92; 95% CI, 1.50-10.26), and weight-to-height ratio of ≥0.5 (OR, 2.22; 95% CI, 1.10-4.50). After controlling for demographics, BMI, and anytime treatment with prednisone or cyclosporine, multivariate models showed that AD was associated with a systolic BP of ≥90 percentile (OR, 2.55; 95% CI, 1.10-5.91). AD also correlated with a family history of hypertension and type II diabetes mellitus, albeit not with family history of obesity or hyperlipidemia.

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Image: PD

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