Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

DOI: https://doi.org/10.46296/yc.v10i19.1016

MANIFESTACIONES CUTÁNEAS ASOCIADAS A LA OBESIDAD

PEDIÁTRICA Y LA DISFUNCIÓN METABÓLICA: UNA REVISIÓN

EXPLORATORIA Y UN MAPA DE LA EVIDENCIA

CUTANEOUS MANIFESTATIONS ASSOCIATED WITH PEDIATRIC

OBESITY AND METABOLIC DYSFUNCTION: A SCOPING REVIEW AND

EVIDENCE MAP

1

2

Fajardo-Martinez Natalia ; Montoya-Medina Andrea Marcela ; Granados-Duque

3

4

5

Natalia ; Solano-Cortés Francisco Javier ; Builes-Iglesias Angela Maria ; Arenas-

8

6

7

Arenas Silvia Juliana ; Cordero-Arroyo Eliana ; Mojica-Barreneche Gendy Mellisa ;

9

10

Toro-Torres Luisa Fernanda ; Estrada-Escobar Adriana Sofia

1

Universidad de Ciencias Aplicadas y Ambientales. Bogotá, Colombia.

Correo: nfajardo788.nf@gmail.com. ORCID ID: https://orcid.org/0009-0009-3617-4110

2

Universidad Libre. Cali, Colombia. Correo : andreamontoyamedina4@gmail.com.

ORCID ID: https://orcid.org/0009-0005-1588-9142

3

Universidad del Valle. Cali, Colombia.

Correo: ngranadosduque@gmail.com. ORCID ID: https://orcid.org/0000-0002-2495-9609

4

Universidad Nacional de Colombia. Bogotá, Colombia.

Correo: fjsolanoc@unal.edu.co. ORCID ID: https://orcid.org/0009-0004-6284-5137

5

Pontificia Universidad Javeriana de Cali. Cali, Colombia.

Correo: angela.builes@outlook.com. ORCID ID: https://orcid.org/0009-0002-0361-8116

6

Universidad Militar Nueva Granada. Bogotá, Colombia.

Correo: silviaarenas24@gmail.com. ORCID ID: https://orcid.org/0009-0008-7751-8779

7

Universidad del Sinú. Monteria, Colombia.

Correo: ely_corar23@hotmail.com. ORCID ID: https://orcid.org/0009-0000-3688-6171

8

Universidad Cooperativa de Colombia. Medellín, Colombia.

Correo: gendymb@gmail.com. ORCID ID: https://orcid.org/0009-0007-5211-4033

9

Universidad Nacional de Colombia. Bogotá, Colombia.

Correo: lftorot@unal.edu.co. ORCID ID: https://orcid.org/0009-0006-6248-5252

10

Universidad de Caldas. Manizales, Colombia.

Correo: sofiaestradae128@gmail.com. ORCID ID: https://orcid.org/0009-0008-4056-6494

Resumen

Los hallazgos cutáneos visibles pueden indicar disfunción metabólica relacionada con la

obesidad en niños, pero su asociación con la adiposidad a menudo se confunde con el valor

diagnóstico o predictivo. Esta revisión exploratoria rápida y mapa de evidencia examinó los

vínculos entre las manifestaciones cutáneas, la obesidad pediátrica y las anomalías

cardiometabólicas. Se utilizaron MEDLINE/PubMed, PubMed Central, sitios web de editores,

contenido indexado en SciELO y búsqueda de citas hasta el 25 de julio de 2026. La evidencia se

clasificó desde la asociación con la obesidad (Nivel 1) hasta la predicción metabólica longitudinal

(

Nivel 5). Se mapearon veinticinco estudios primarios publicados entre 2008 y 2025, incluido un

estudio de edad mixta retenido como evidencia contextual cuyas estimaciones agregadas no se

trataron como específicas para la población pediátrica. La acantosis nigricans tuvo la evidencia

más desarrollada, con asociaciones que involucran adiposidad, resistencia a la insulina, presión

arterial, disglucemia, anomalías lipídicas y, en algunas cohortes, esteatosis hepática. El

Información del manuscrito:

Fecha de recepción: 14 de julio de 2026.

Fecha de aceptación: 10 de septiembre de 2026.

Fecha de publicación: 28 de octubre de 2026.

1810

Fajardo-Martinez et al. (2026)

rendimiento diagnóstico varió; Un estudio pediátrico reportó una sensibilidad del 73,5% y una

especificidad del 50,0% para la resistencia a la insulina. El análisis de mediación sugirió que el

índice de masa corporal explicaba gran parte de la asociación en niños mexicoamericanos. Otros

hallazgos, incluyendo acrocordones, estrías distensas, queratosis pilaris, acné, hiperhidrosis,

intertrigo, infecciones, hiperqueratosis plantar e hidradenitis supurativa, se asociaron con la

obesidad, pero su valor metabólico independiente seguía siendo incierto. Las cohortes

longitudinales vincularon la adiposidad con la hidradenitis supurativa y las dermatosis

inmunomediadas posteriores; no establecieron estas afecciones como predictores de futuras

enfermedades metabólicas. La acantosis nigricans puede respaldar la evaluación del riesgo

clínico, pero no puede reemplazar la evaluación metabólica basada en guías. Ninguno de los

estudios mapeados proporcionó evidencia convincente de que un hallazgo cutáneo prediga de

forma independiente futuras enfermedades metabólicas pediátricas después de tener en cuenta

la adiposidad. Se necesitan definiciones estandarizadas, análisis ajustados, estudios de

rendimiento diagnóstico y cohortes prospectivas..

Palabras claves: Obesidad pediátrica; acantosis nigricans; resistencia a la insulina; síndrome

metabólico; manifestaciones cutáneas; hidradenitis supurativa; acrocordones; revisión

exploratoria.

Abstract

Visible skin findings may signal obesity-related metabolic dysfunction in children, but their

association with adiposity is often conflated with diagnostic or predictive value. This rapid scoping

review and evidence map examined links between cutaneous manifestations, pediatric obesity,

and cardiometabolic abnormalities. MEDLINE/PubMed, PubMed Central, publisher websites,

SciELO-indexed content, and citation searching were used through July 25, 2026. Evidence was

classified from association with obesity (Level 1) to longitudinal metabolic prediction (Level 5).

Twenty-five primary studies published from 2008 to 2025 were mapped, including one mixed-age

study retained as contextual evidence whose aggregate estimates were not treated as pediatric-

specific. Acanthosis nigricans had the most developed evidence, with associations involving

adiposity, insulin resistance, blood pressure, dysglycemia, lipid abnormalities, and, in some

cohorts, hepatic steatosis. Diagnostic performance varied; one pediatric study reported 73.5%

sensitivity and 50.0% specificity for insulin resistance. Mediation analysis suggested that body

mass index explained much of the association in Mexican American children. Other findings,

including acrochordons, striae distensae, keratosis pilaris, acne, hyperhidrosis, intertrigo,

infections, plantar hyperkeratosis, and hidradenitis suppurativa, were associated with obesity, but

their independent metabolic value remained uncertain. Longitudinal cohorts linked adiposity with

subsequent hidradenitis suppurativa and immune-mediated dermatoses; they did not establish

these conditions as predictors of future metabolic disease. Acanthosis nigricans can support

clinical risk assessment but cannot replace guideline-based metabolic evaluation. None of the

mapped studies provided convincing evidence that a cutaneous finding independently predicts

future pediatric metabolic disease after accounting for adiposity. Standardized definitions,

adjusted analyses, diagnostic-performance studies, and prospective cohorts are needed.

Keywords: Pediatric obesity; acanthosis nigricans; insulin resistance; metabolic syndrome; skin

manifestations; hidradenitis suppurativa; acrochordons; scoping review.

Abbreviations

Abbreviation

Definition

AN

acanthosis nigricans

BMI

HOMA-IR

HS

body mass index

Homeostatic Model Assessment for Insulin Resistance

hidradenitis suppurativa

insulin-like growth factor

insulin resistance

IGF

IR

JBI

Joanna Briggs Institute

Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Abbreviation

PCC

Definition

Population-Concept-Context

Peer Review of Electronic Search Strategies

PRESS

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Extension for Scoping Reviews

PRISMA-S

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Literature Search Extension

ALT

alanine aminotransferase

AUC

area under the receiver operating characteristic curve

blood pressure

BP

HDL

high-density lipoprotein

HOMA2-IR

NPV

updated Homeostatic Model Assessment for Insulin Resistance

negative predictive value

OGTT

PPV

oral glucose tolerance test

positive predictive value

1. Introduction

The skin is a visible interface

between

adiposity,

endocrine

Pediatric obesity is a chronic,

relapsing disease with global

cardiometabolic consequences. In

signaling, inflammation, mechanical

stress, sweating, barrier function,

and microbial ecology.⁹^,¹⁰Acanthosis

nigricans (AN), acrochordons, striae

distensae, keratosis pilaris, plantar

2022, more than 390 million children

and adolescents aged 5-19 years

had overweight, including more than

hyperkeratosis,

hyperhidrosis,

160 million living with obesity.1

intertrigo, bacterial and fungal

infections, acne, psoriasis, atopic

Excess adiposity in childhood is

associated

with

hypertension,

glucose

dermatitis,

and

hidradenitis

dyslipidemia,

impaired

suppurativa (HS) have all been

reported in pediatric populations with

overweight or obesity.¹¹^-³⁶However,

three distinct questions are often

merged: whether a lesion is more

common with obesity; whether it

metabolism, metabolic dysfunction-

associated steatotic liver disease,

and persistence of obesity into

adulthood.1-3 The severity of obesity

and insulin resistance already stratify

metabolic-syndrome risk during

childhood.³

correlates

with

metabolic

biomarkers; and whether it can

1812

Fajardo-Martinez et al. (2026)

independently discriminate or predict

metabolic disease.

applicable.⁵^,⁶

Reporting Items for Systematic

Reviews and Meta-Analyses

PRISMA) framework was used as a

The

Preferred

This distinction is clinically important.

A common lesion may reflect

adiposity without adding information

beyond BMI, whereas a useful

clinical marker should demonstrate

(

reporting standard. No prospective

protocol was prepared or registered,

and the electronic search did not

undergo independent peer review

using the Peer Review of Electronic

incremental after

adjustment, reproducible diagnostic

discrimination, or longitudinal

association

Search

Strategies

(PRESS)

framework.⁷

prediction. The objective of this

review was to map the pediatric

evidence across these levels and to

Review question and eligibility

The review question was: What

cutaneous manifestations have been

associated with obesity, insulin

resistance, metabolic syndrome, or

develop cautious, guideline-

a

compatible clinical interpretation.

2. Materials and methods

abnormalities in children and

adolescents, and what level of

evidence supports their use as

clinical metabolic markers? Eligibility

was structured using the Population-

Concept-Context framework (Table

Design and reporting framework

This rapid scoping review and

evidence map was informed by

Joanna Briggs Institute guidance.4

Reporting followed PRISMA-ScR

and PRISMA-S principles where

1).

Table 1. Population-Concept-Context framework and eligibility criteria

Domain

Included

Excluded

Operational note

Population

Human participants aged 0– Adult-only data; mixed- One study aged 2–24 years

19

years or clearly age aggregate results was retained as contextual

a

separable pediatric subgroup; were

excluded

from evidence, with its applicability

explicitly identified.

mixed-age evidence was pediatric-specific

considered separately for inference.

context.

1

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Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Domain

Included

Excluded

Operational note

Concept

At least one cutaneous Skin disorders mentioned The primary interest was

manifestation evaluated in without

relation to overweight, obesity/metabolic

obesity, adiposity, insulin analysis.

resistance, dysglycemia,

dyslipidemia, hypertension,

hepatic steatosis, or

metabolic syndrome.

an marker value, not merely

treatment.

Context

Any country

clinical/community setting.

or No geographic exclusion. Hospital, outpatient, school,

community, and

administrative cohorts were

eligible.

Evidence type Primary

observational Case reports, narrative Reviews were used only for

studies, diagnostic studies, reviews

as

primary context and citation chasing.

trials with relevant data, and evidence, editorials, and

sufficiently informative large nonhuman studies.

case series.

searching.

Search

concepts

Information sources and search

approach

combined pediatric terms, obesity

and metabolic terms, and general

and lesion-specific dermatologic

terms. The PubMed strategy and

supplementary search concepts are

provided in Supplementary Appendix

A.

Searches were performed through

July 25, 2026, using MEDLINE

through PubMed, PubMed Central,

publisher websites, SciELO-indexed

content, complementary

and

backward and forward citation

Table 2. Information sources and their application

Source

Coverage

Search date Purpose

Application

PubMed/MEDLINE Database

July 25,

Primary bibliographic Bibliographic identification

search

inception to July 2026

25, 2026

PubMed Central

Available full-text July 25,

archive 2026

Full-text verification

Full-text review

Publisher websites Available article July 25,

Metadata, tables,

errata, and full-text

verification

Article details and

corrections

pages/full text

2026

SciELO and

regional journal

platforms

Available

coverage

July 25,

2026

Latin American and

regional evidence

Regional evidence

retrieval

Citation chasing

References and July 25,

citing articles 2026

Identify linked primary Linked studies and

studies and errata corrections

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Fajardo-Martinez et al. (2026)

Study selection, data charting,

and verification

validated

instruments. Studies were not

excluded on the basis of

design-specific

Titles, abstracts, and available full

texts were evaluated against the

eligibility criteria. Screening and data

charting used automated support

methodological concerns. Evidence

was classified as Level 1, association

with obesity; Level 2, unadjusted

metabolic association; Level 3,

metabolic association persisting after

relevant adjustment; Level 4,

diagnostic discrimination; or Level 5,

longitudinal prediction of future

metabolic disease. These levels

describe the function of the evidence,

rather than overall study quality or

certainty.

without

independent

duplicate

human verification. Numerical results

were retained when traceable to a

primary report or correction. Missing

information was recorded as not

reported rather than interpreted as a

negative finding. The published 2024

erratum for Hasse et al. was used in

place of the superseded values.²⁸^,²⁹

One study with participants aged 2–

Synthesis

2

4 years was retained for contextual

Findings

were

by

Study

synthesized

cutaneous

counts,

mapping; its aggregate estimates

were not interpreted as pediatric-

specific.²¹

descriptively

manifestation.

publication year, country, design,

and manifestation–outcome matrices

were generated from the charted

study set. No meta-analysis was

undertaken because definitions,

populations, thresholds, and effect

measures were heterogeneous.

Numerical selection-flow counts are

not presented because a record-level

screening and deduplication log was

not retained. Figure 1 summarizes

the review workflow.

Critical appraisal and evidence

classification

A descriptive appraisal considered

population

pediatric

representativeness,

obesity

skin

definitions,

standardized

examination,

objective metabolic measurement,

confounder adjustment, and

temporality. Domain-level concerns

are summarized in Table 7 and

Supplementary Appendix C; this was

not a formal duplicate appraisal with

1

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Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

3

. Results

Evidence-base characteristics

Twenty-five primary studies

numbers, followed by Türkiye, Brazil,

and Denmark (Figure 3). Most

studies were cross-sectional clinical

investigations; only two large cohorts

directly

weight-to-skin-disease relationships

Figure 4). Sample sizes ranged from

5 to more than 2.1 million

assessed

longitudinal

published between 2008 and 2025

were charted (Figure 2), including

one mixed-age study retained as

contextual evidence. Its aggregate

estimates were not interpreted as

pediatric-specific. India and the

United States contributed the largest

(

5

participants (Figure 7). Detailed

characteristics are provided in

Supplementary Appendix B.

Figure 1. Workflow of the rapid scoping review and evidence map. The diagram summarizes

the review stages without numerical selection-flow estimates.

Figure 2. Publication timeline of the 25 charted primary studies.

1816

Fajardo-Martinez et al. (2026)

Figure 3. Geographic distribution of the charted evidence base. International denotes a

multicenter cohort spanning more than one country.

Figure 4. Distribution of study designs. Cross-sectional clinical studies dominated the evidence

base.

examination studies consistently

Spectrum

of

cutaneous

demonstrated that children with

obesity carry multiple simultaneous

skin findings. In the comparative

manifestations

AN was evaluated most often,

followed by acne, acrochordons,

striae distensae, infections/intertrigo,

and HS (Figure 5). Clinical

Turkish

acrochordons,

intertrigo, folliculitis,

cohort,

striae,

AN,

keratosis

pilaris,

seborrheic

1

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Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

dermatitis, and facial erythema were

more frequent in children with obesity

than in normal-weight controls.²⁷In

each affected 63.1%, AN 44.7%,

acne 40.8%, acrochordons 25.2%,

and plantar hyperkeratosis

17.5%.²⁸^,²⁹

the erratum-corrected German

cohort, striae and keratosis pilaris

Figure 5. Number of studies contributing to the selected manifestations charted in this evidence

map. Counts represent the charted categories, rather than an exhaustive inventory of all

reported skin findings.

Table 3. Representative prevalence estimates from direct dermatologic examination studies

Study

Population

Most frequent reported

findings

Selected

prevalence

Interpretive caution

Gupta 2017

100 participants, age 3- AN; striae; fungal

42%; 19%; 16%;

12%; 10%

Adult BMI cutoff and

no control group

18; BMI >30 kg/m2

infection/intertrigo;

acrochordons; acne

Guven 2022

82 with obesity vs 86

controls

Striae; AN; acrochordons;

keratosis pilaris; intertrigo

72.0% vs 26.7%;

63.4% vs 3.5%;

Single-center and

multiple comparisons

17.1% vs 1.2%;

32.9% vs 17.4%;

11.0% vs 0%

Hasse

103 tertiary weight-

program participants

Striae; keratosis pilaris;

AN; acne; acrochordons

63.1%; 63.1%;

44.7%; 40.8%;

25.2%

Values reflect the

published 2024

erratum

2023/erratum

024

2

Thomas 2024

150 participants aged

AN; striae; acne;

dermatophytosis

74.7%; 32.7%;

20.0%; 17.3%

No normal-weight

controls or metabolic

laboratory data

5-19 with

overweight/obesity

Mohan 2025

150 children with

obesity

AN; striae; pityriasis

versicolor; seborrheic

dermatitis;

76.0%; 24.0%;

16.7%; 14.7%;

12.7%

Single-center; limited

adjusted analyses

dermatophytosis

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Fajardo-Martinez et al. (2026)

Acanthosis nigricans

The evidence does not support a

simple causal or diagnostic

interpretation. Aswani et al. reported

3.5% sensitivity and 50.0%

AN had the strongest and most

consistent

metabolic

evidence.

7

Across ethnically and geographically

diverse cohorts, AN was associated

with BMI, central adiposity, fasting

insulin, HOMA-IR, blood pressure,

glucose abnormalities, triglycerides,

specificity for AN as a marker of

insulin resistance in a small White

13

pediatric cohort. Other populations

have shown a pattern of higher

specificity but lower sensitivity

depending on AN grading, ethnicity,

and insulin-resistance thresholds. In

Mexican American children, AN

severity correlated with HOMA-IR

low

high-density

lipoprotein

cholesterol, and, in a Chinese cohort,

alanine aminotransferase and fatty

liver.¹¹^-¹³^,¹⁵^,¹⁷^,²⁰^,²⁴^,³⁴The 2025 Indian

school-based study found AN in

and

inflammatory/metabolic

46.4% of children with overweight or

variables, but structural modeling

suggested that BMI mediated much

obesity and reported higher BMI,

waist circumference, blood pressure,

glycemia, insulin, and HOMA-IR

among affected participants.³⁴

24

of the relationship. Thus, AN is best

viewed as a visible risk-enrichment

sign rather than a stand-alone test.

Table 4. Key pediatric studies of acanthosis nigricans and metabolic outcomes

Study

N

Population

Metabolic

outcomes

Key result

Marker interpretation

Aswani 2011

76

White children with

obesity

HOMA-IR

Sensitivity 73.5%;

specificity 50.0%; PPV

Level 4, but imprecise

and population-

dependent

54.3%; NPV 70.0%

Brickman

236

543

670

545

High-risk multiethnic

youth

Glucose

homeostasis, BP,

HDL-C

AN identified a group with Level 2-3; not a stand-

2010

frequent metabolic

alone diagnostic study

abnormalities

Ng 2014

Chinese youth with

overweight/obesity

Insulin, HOMA-IR,

OGTT, lipids, BP,

ALT, fatty liver

Broad adverse metabolic

profile with AN

Level 2; adjustment

varied

Lopez-

Alvarenga

Mexican American

children

HOMA-IR, CRP,

HDL-C

BMI mediated much of

the AN-IR association

Important evidence

against overclaiming

independence

2020

Das 2025

School-based

overweight/obesity

sample

Waist, glucose,

insulin, HOMA-IR,

BP, HDL-C

AN associated with

multiple cardiometabolic

risk factors

Level 2; cross-

sectional

Acrochordons

commonly in axillary sites.¹⁸^,¹⁹^,²⁶^-³¹

The 2024 pediatric cohort of 55

patients found a high burden of

Acrochordons were reported in

several obesity-clinic cohorts,

1

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Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

obesity and metabolic comorbidity

compared with propensity-matched

controls; three of 55 patients (5.5%)

met metabolic-syndrome criteria,

although only 21 underwent a

complete metabolic evaluation.³¹

However, the study did not

demonstrate that acrochordons

uniformly controlled. Their highest

supported category is Level 2.

Intertrigo and recurrent infections

Intertrigo, dermatophytosis, candidal

or other fungal disease, folliculitis,

and pyoderma were repeatedly

observed in clinical cohorts and large

predict

metabolic

disease

_d_a_t_a_s_e_t_s_.16,18,19,25-

administrative

independently of adiposity. Current

evidence therefore reaches Level 2,

27,33,35,36

The likely pathways include

occlusion, moisture, friction, barrier

disruption, and altered host-microbial

interactions. Pediatric studies rarely

tested whether infection burden

not

diagnostic

or

predictive

validation.

Striae,

keratosis

pilaris,

independently

tracks

insulin

hyperhidrosis, acne, and plantar

hyperkeratosis

resistance or dysglycemia. These

findings support Level 1 association

with obesity, not their use as

metabolic screening tests.

Striae distensae and keratosis pilaris

were among the most prevalent

findings in direct examination

studies.¹⁹^,²⁶^-³⁰In the German cohort,

HOMA was associated with keratosis

pilaris and acne, but not reported as

Hidradenitis suppurativa

HS showed a robust relationship with

adiposity but limited evidence as a

metabolic marker. Screening 195

Danish children with BMI above the

independently

associated

after

comprehensive adjustment.²⁸^,²⁹The

Turkish case-control study reported

positive correlations between insulin

resistance and keratosis pilaris,

striae, AN, hyperhidrosis, and plantar

hyperkeratosis.³⁰These signals are

hypothesis-generating; puberty, sex,

mechanical factors, skin phototype,

and obesity severity were not

90th percentile identified five

clinically confirmed, generally mild

22

cases. In the international pediatric

HS cohort, obesity was the most

frequent comorbidity and scarring

was present in nearly half at first

25

assessment. A population cohort of

347,200 schoolchildren linked higher

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Fajardo-Martinez et al. (2026)

childhood BMI with later HS,

predominantly in adulthood; weight

normalization before puberty was

associated with attenuated risk.²³

These data support obesity as a risk

factor for HS; they do not show that

HS independently predicts future

metabolic dysfunction.

early and persistent obesity, with

atopic dermatitis.¹⁴A nationwide

Korean cohort of more than 2.1

million children associated childhood

obesity with subsequent atopic

dermatitis, psoriasis, and alopecia

areata. Weight gain was associated

with higher atopic-dermatitis risk,

whereas transition to normal weight

was associated with lower risk.³²

These longitudinal data strengthen

temporal inference for adiposity as

an exposure, but they do not validate

these dermatoses as early metabolic

markers.

Atopic dermatitis, psoriasis, and

other

immune-mediated

dermatoses

Large studies support an obesity-to-

inflammatory-skin-disease

relationship. A pediatric case-control

study associated obesity, particularly

Figure 6. Evidence heat map for selected manifestations and metabolic or anthropometric

outcomes. Counts indicate the volume of charted evidence, not effect magnitude or certainty.

1

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Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Figure 7. Bubble plot of publication year and study sample size. Bubble size also represents

sample size; administrative and nationwide cohorts dominate the upper range. For Epstein et

al., sample size represents the sum of the two cohorts reported in the original Table 1.

Figure 8. Evidence-gap map for selected manifestations. Acanthosis nigricans reached Level 4

because diagnostic-performance data were available; no charted manifestation had evidence

meeting Level 5 criteria for longitudinal metabolic prediction.

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Fajardo-Martinez et al. (2026)

Table 5. Evidence supporting cutaneous manifestations as potential metabolic markers

Manifestation

Highest What is supported

level

What is not

established

Clinical interpretation

Acanthosis

nigricans

Level 4

Consistent obesity and Reliable

metabolic associations; alone

limited diagnostic- longitudinal

performance data

stand- Risk-enrichment

diagnosis; that should

sign

trigger

complete clinical risk

assessment

prediction

independent

adiposity

of

Acrochordons

Level 2

Association with obesity Independent

and metabolic discrimination

Consider broader risk

or profile, but do not infer

comorbidity in a small prediction

cohort

metabolic syndrome

from skin tags alone

Striae distensae

Keratosis pilaris

Hyperhidrosis

Level 2

Common with obesity; Incremental

occasional unadjusted metabolic value

IR correlation

Primarily a marker of

tissue

stretching/adiposity

Common with obesity; Reproducible

HOMA/IR signals in two independent

Hypothesis-generating

only

studies

association

Reported

more Validated metabolic Treat symptoms and

frequently and correlated screening value

assess overall obesity

risk

with

IR

in

one

comparative study

Intertrigo/infections Level 1

Repeated

association

obesity Independent

metabolic

Evaluate

local

mechanical/infectious

or drivers; follow obesity

guidelines separately

association

prediction

Hidradenitis

suppurativa

Level 1

Strong association with HS-to-future-

obesity and longitudinal metabolic-disease

Treat HS and assess

comorbidity burden; not

obesity-to-HS risk

prediction

a

validated metabolic

test

Acne/atopic

Level 1-2 Obesity/inflammation

Independent skin- Interpret within puberty

dermatitis/psoriasis

associations;

some to-metabolic

and

inflammatory

HOMA association for prediction

acne

context

of the association. The practical

conclusion is therefore narrower than

the phrase “early metabolic marker”

may imply: AN increases clinical

suspicion, but it cannot confirm or

exclude insulin resistance and

should not determine laboratory

testing in isolation.

4

. Discussion

Principal findings

This evidence map identifies AN as

the only pediatric obesity-associated

skin finding with a substantial body of

metabolic correlation and at least

some diagnostic-discrimination data.

Even for AN, results vary across

populations and definitions, and

adiposity explains an important part

Other manifestations are common

and clinically important but less

mature as metabolic indicators.

1

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Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Acrochordons,

pilaris, plantar

striae,

keratosis

dysregulation plausibly contribute to

psoriasis, atopic dermatitis, HS, and

acne, but lesion-specific pediatric

causal evidence remains incomplete.

Mechanical friction, tissue stretching,

occlusion, and sweating provide

stronger direct explanations for

hyperkeratosis,

hyperhidrosis, acne, intertrigo, and

infections may reflect combinations

of adiposity, mechanical stress,

endocrine milieu, puberty, barrier

dysfunction, and inflammation. Their

associations with HOMA-IR or lipid

abnormalities generally arise from

small cross-sectional cohorts and

often lack adjustment for BMI

striae,

intertrigo,

plantar

hyperkeratosis, and some follicular

disorders. Barrier and microbiome

alterations

susceptibility to bacterial and fungal

infection, although pediatric

may

increase

severity,

puberty,

waist

sex,

circumference,

ethnicity, and

treatment. HS and immune-mediated

dermatoses have stronger obesity-

metabolic mediation is insufficiently

studied.

association

evidence,

including

temporal evidence, but the temporal

direction examined is mainly obesity

preceding skin disease.

Biological plausibility

Hyperinsulinemia

signaling through insulin and insulin-

like growth factor pathways,

can

increase

promoting keratinocyte and fibroblast

proliferation; this mechanism is

biologically coherent for AN and

possibly acrochordons.⁹^,¹⁰Pediatric

clinical data directly support the

hyperinsulinemia-AN

whereas molecular detail is largely

extrapolated from adult or

association,

experimental evidence. Chronic low-

grade inflammation and adipokine

1824

Fajardo-Martinez et al. (2026)

Figure 9. Conceptual pathophysiology. Solid clinical support is strongest for

obesity/hyperinsulinemia and acanthosis nigricans; several other pathways are extrapolated from

adult or experimental evidence and should be regarded as plausible rather than proven.

finding

should

enrich

clinical

Clinical implications

concern, not substitute for age- and

A deliberate skin examination can

improve recognition of obesity-

related morbidity and quality-of-life

impairment. When AN, extensive

risk-based

Atypical,

recommendations.

rapidly progressive,

generalized, mucosal, or non-

obesity-associated AN requires

evaluation for alternative endocrine,

medication-related, genetic, or rarely

paraneoplastic causes.

acrochordons,

recurrent

HS is

intertrigo/infections,

or

identified, the clinician should

document morphology, distribution,

severity, symptoms, scarring, and

alternative diagnoses; assess BMI

percentile or z score, waist measures

when appropriate, blood pressure,

pubertal stage, family history, and

obesity trajectory; and follow

accepted pediatric obesity guidance

for laboratory evaluation.2 The skin

1

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Revista Científica Multidisciplinaria Arbitrada YACHASUN. Volumen 10, Número 19 (Ed. jul – dic. 2026) ISSN: 2697-3456

Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Figure 10. Proposed clinical evaluation pathway. This pathway is derived from the mapped

evidence, is not a validated prediction rule, and does not replace pediatric obesity guidelines or

clinical judgment.

discrimination,

and

incremental

Research priorities

value beyond BMI and waist

measures. Longitudinal cohorts are

needed to test whether any lesion

predicts incident prediabetes, type 2

diabetes, metabolic syndrome, or

Priority studies should use age- and

sex-specific

obesity

definitions;

standardized lesion definitions and

severity scores; trained dermatologic

examiners;

objective

metabolic

steatotic

liver

disease

after

phenotyping;

prespecified

adjustment. None of the studies

mapped in this review provided

convincing Level 5 evidence.

adjustment for adiposity, puberty,

sex,

ethnicity,

and

socioeconomic

medication; and

factors,

sufficient representation across skin

tones. Diagnostic studies should

report

sensitivity,

ratios,

specificity,

calibration,

likelihood

1826

Fajardo-Martinez et al. (2026)

Table 6. Evidence gaps and research priorities

Gap

Why it matters

Preferred design

Minimum reporting

elements

No longitudinal

metabolic prediction

Cross-sectional

association

establish temporal or

incremental value

Prospective

cannot multicenter cohort

Baseline

lesion

severity,

repeated metabolic outcomes,

BMI/waist trajectory, adjusted

risk estimates

Heterogeneous AN

and IR definitions

Performance estimates Diagnostic-accuracy

Explicit index-test grading,

are not transportable

study

prespecified

HOMA/OGTT

reference,

sensitivity,

specificity, likelihood ratios,

AUC

Understudied lesions Common findings may Comparative

be markers or merely cohort

correlates

clinical Normal-weight

standardized

controls,

dermatology

exam, puberty and phototype

Limited adjustment

Adiposity may fully Multivariable or causal- BMI severity, central adiposity,

explain associations

inference analysis

age, sex, puberty, ethnicity,

socioeconomic status

Skin-tone and

geographic gaps

Visual recognition and International

prevalence differ across prospective

Validated skin-tone measure,

region, examiner training,

inter-rater reliability

populations

collaboration

Sparse patient-

Burden extends beyond Mixed-

Dermatologic quality of life,

centered outcomes

biomarkers

methods/longitudinal

study

stigma,

treatment access

pain,

scarring,

mediated dermatoses are clinically

relevant but the mapped studies did

not establish validated independent

5

. Conclusions

Cutaneous

manifestations

are

frequent in children and adolescents

with obesity, but evidence maturity

differs sharply by lesion. AN has the

most consistent links with adiposity

and metabolic dysfunction and can

usefully enrich risk assessment. Its

sensitivity and specificity are

variable, and its association may be

substantially mediated by obesity

severity; it should not be used to

metabolic

discrimination

or

longitudinal prediction. Within the

studies mapped in this review, no

lesion had convincing Level 5

evidence for prediction of future

pediatric metabolic disease. Skin

examination

should

prompt

comprehensive,

guideline-based

evaluation rather than replace it.

diagnose

or

exclude

insulin

resistance. Acrochordons, striae,

keratosis pilaris, hyperhidrosis, acne,

intertrigo,

infections,

plantar

hyperkeratosis, HS, and immune-

1

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Cutaneous manifestations associated with pediatric obesity and metabolic dysfunction: A scoping review and evidence map.

Figure 11. Graphical abstract. Summary of the evidence hierarchy and clinical interpretation

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