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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 28-30

Cutaneous manifestations of obesity in children: A prospective study


Treatwell Skin Centre, Jammu, Jammu and Kashmir, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Mrinal Gupta
Treatwell Skin Centre, Jammu - 180 001, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.193004

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  Abstract 


Background: Obesity is a chronic disorder with rising prevalence that affects several organs, including the skin. Although it is more common in adults, the prevalence in the pediatric population is growing rapidly. Obesity is associated with a large number of cutaneous manifestations which are directly related to the age of onset and duration of obesity.
Materials and Methods: This was a prospective study in which children aged 3 years or more with body mass index (BMI) >30 kg/m2 were included in the study. After informed consent from the parents/attendants, demographic details, height, and weight were documented. All the children were subjected to a detailed dermatological examination by an experienced dermatologist, and all the cutaneous changes were carefully recorded in a predesigned pro forma.
Results: A total of 100 children (male: 61, female: 39) were included in the study. The mean age of the participants was 11.3 ± 1.3 years and the mean BMI was 32.6 ± 1.36 kg/m2. Majority of the patients (71%) had Class I obesity (BMI 30.00–34.99) while 27% had Class II obesity (BMI 35.00–39.99). The most common cutaneous manifestations among the children were acanthosis nigricans (42%), striae (19%), fungal infections and intertrigo (16%), acrochordons (12%), acne (10%), hirsutism (8%), and viral and bacterial infections (5%). Other less common associations were psoriasis, xanthomas, corns, plantar hyperkeratosis, and miliaria.
Conclusion: Likewise in adults, obesity is associated significantly with certain dermatoses in children also. As the prevalence of obesity is increasing each day, understanding of these dermatoses is necessary both for the pediatricians as well as for dermatologists for early diagnosis and management.

Keywords: Acanthosis nigricans, acrochordons, children, hirsutism, obesity


How to cite this article:
Gupta M. Cutaneous manifestations of obesity in children: A prospective study. Indian J Paediatr Dermatol 2017;18:28-30

How to cite this URL:
Gupta M. Cutaneous manifestations of obesity in children: A prospective study. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Sep 15];18:28-30. Available from: http://www.ijpd.in/text.asp?2017/18/1/28/193004




  Introduction Top


Overweight and obesity are defined by the World Health Organization (WHO) as abnormal or excessive fat accumulation that may impair health. The prevalence of obesity has increased manifold over the last few years in both the developed and developing nations and has reached to epidemic proportions. It is common in adults, but the prevalence among children has also been rising alarmingly now. According to the WHO, 20% of children and adolescents in Europe are overweight, and of these, one-third are obese.[1] Obesity carries a significant impact on the physical and psychological health. Obesity has shown a well-established relation with conditions as coronary heart disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, osteoarthritis, and obstructive sleep apnea and is indirectly associated to anxiety, impaired social interaction, and depression.

The skin is a commonly affected organ in obesity. Obesity has been implicated to cause a wide range of dermatologic disorders including acanthosis nigricans, acrochordons, keratosis pilaris, hirsutism, striae distensae, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, and psoriasis.[2]

The WHO uses body mass index (BMI) to classify underweight, overweight, and obesity. A BMI of 18.5–24.9 kg/m 2 is taken as normal, BMI 25–29.9 kg/m 2 overweight, and BMI >30 kg/m 2 taken as obese. Obesity can be further characterized as by BMI as Class I (30–34.9 kg/m 2), Class II (35–39.9 kg/m 2), and Class III (>40 kg/m 2).[3]

We undertook this study to find out the prevalence of cutaneous manifestations in obesity in pediatric population and to analyze the relation with BMI.


  Materials and Methods Top


This was a prospective study carried out over a period of 1 year from May 2015 to April 2016 in our center. A total of 100 children aged 3–18 years or more with BMI >30 kg/m 2 were included in the study. After taking informed consent from the parents/attendants, demographic details, height, weight, and systemic examination were done. A detailed cutaneous examination was performed, and all the findings were noted on a predesigned pro forma. Relevant investigations were carried out, wherever deemed necessary.


  Results Top


A total of 100 children (male:female - 61:39) were included in the study with a mean age of 11.3 ± 1.3. The mean BMI of the patients was 32.6 ± 1.36 kg/m 2. Majority of the patients (71%) had Class I obesity while 27% had Class II obesity and 2% had Class III obesity. The most common cutaneous changes observed in our patient group were acanthosis nigricans (42%), striae (19%), fungal infections and intertrigo (16%), acrochordons (12%), acne (10%), hirsutism (8%), and viral and bacterial infections (5%) [Figure 1],[Figure 2],[Figure 3]. Keratosis pilaris was seen in two patients while xanthomas, psoriasis, corns, plantar hyperkeratosis, and miliaria were seen in one patient each. The incidence of acanthosis nigricans, intertrigo, and acrochordons was higher in children with Class II obesity while striae, acne, and hirsutism were more common in Class II obesity [Table 1]. One child with Class II obesity had Type II diabetes mellitus while one child with Class I obesity had hypertriglyceridemia.
Figure 1: Acanthosis nigricans in an 8-year-old boy

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Figure 2: Hirsutism in a 15-year-old girl

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Figure 3: The skin tags with acanthosis nigricans in a 16-year-old boy

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Table 1: Frequency of various dermatoses in different classes of obesity

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  Discussion Top


The cutaneous manifestations of obesity are directly related to the age of onset, duration, and severity of the underlying disease; the incidence is greater when obesity is associated with diabetes and/or insulin resistance syndrome. In a study performed by Boza et al., dermatoses that showed a statistically significant relationship with obesity, compared with the control group, were striae, plantar hyperkeratosis, acrochordons, intertrigo, pseudoacanthosis nigricans, keratosis pilaris, lymphedema, and bacterial infections.[4]

In our study, acanthosis nigricans was the most common dermatosis seen in 42% of the children. Acanthosis nigricans is the most common dermatologic manifestation of pediatric obesity, occurring in 66% of overweight adolescents. It is the most common early symptom observed in children who present with obesity and/or insulin resistance syndrome.[5] Hud et al. observed that 74% of obese population show acanthosis nigricans along with elevated plasma insulin levels.[6]

Striae were the second most common cutaneous manifestation seen in 19% of the children. In childhood, the presence of striae is directly related to excess weight, with an incidence of up to 40% in children with moderate to severe obesity. Boza et al. have also reported an association between striae and increasing grades of obesity.[4]

Skin infections are also more common in obese patients, mainly due to friction of the skin in body folds resulting in intertrigo and superadded infection. Other infections found in obese patients include pachyonychia, furunculosis, and erythrasma caused by Corynebacterium minutissimum. Boza et al. found a statistically significant association of obesity with infections. In our study, infections were seen in 19% of the patients and were more common in children with Class II obesity.[4]

Acne is another common manifestation of obesity and has been attributed to obesity-induced hyperinsulinemia. Studies have reported a correlation between the degree of obesity and acne incidence.[4] In our study, acne was a common presentation seen in 10% of the patients and was more frequent in Class II obesity.

Hirsutism was also a common manifestation in our study group seen more among patients with Class II obesity. Ahsan et al. also noted a correlation between obesity and hirsutism and reported a frequency of 16% in obese patients.[7]


  Conclusion Top


As the prevalence of obesity is increasing among the children, the pediatricians and dermatologists should be aware of its various manifestations including the cutaneous ones to ensure their early diagnoses and treatment, which are as common as in adults, and can be a source of great physical or psychological morbidity.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Lobstein T, Millstone E; PorGrow Research Team. Context for the PorGrow study: Europe's obesity crisis. Obes Rev 2007;8 Suppl 2:7-16.  Back to cited text no. 1
    
2.
Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am Acad Dermatol 2007;56:901-16.  Back to cited text no. 2
    
3.
Bremmer S, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, et al. Obesity and psoriasis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2010;63:1058-69.  Back to cited text no. 3
    
4.
Boza JC, Trindade EN, Peruzzo J, Sachett L, Rech L, Cestari TF. Skin manifestations of obesity: A comparative study. J Eur Acad Dermatol Venereol 2012;26:1220-3.  Back to cited text no. 4
    
5.
Stuart CA, Pate CJ, Peters EJ. Prevalence of acanthosis nigricans in an unselected population. Am J Med 1989;87:269-72.  Back to cited text no. 5
    
6.
Hud JA Jr., Cohen JB, Wagner JM, Cruz PD Jr. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol 1992;128:941-4.  Back to cited text no. 6
    
7.
Ahsan U, Jamil A, Rashid S. Cutaneous manifestations in obesity. J Pak Assoc Dermatol 2014;24:21-4.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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