CUTANEOUS MANIFESTATIONS ASSOCIATED WITH PEDIATRIC OBESITY AND METABOLIC DYSFUNCTION: A SCOPING REVIEW AND EVIDENCE MAP
Keywords:
Pediatric obesity; acanthosis nigricans; insulin resistance; metabolic syndrome; skin manifestations; hidradenitis suppurativa; acrochordons; scoping reviewAbstract
DOI: https://doi.org/10.46296/yc.v10i19.1016
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.
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World Health Organization. Obesity and overweight. Updated December 8, 2025. Accessed July 25, 2026.
Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640. [DOI]
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350(23):2362-2374. doi:10.1056/NEJMoa031049. [DOI]
Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. doi:10.11124/JBIES-20-00167. [DOI]
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850. [DOI]
Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Syst Rev. 2021;10:39. doi:10.1186/s13643-020-01542-z. [DOI]
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-46. doi:10.1016/j.jclinepi.2016.01.021. [DOI]
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. [DOI]
Uzuncakmak TK, Akdeniz N, Karadag AS. Cutaneous manifestations of obesity and the metabolic syndrome. Clin Dermatol. 2018;36(1):81-88. doi:10.1016/j.clindermatol.2017.09.014. [DOI]
Shipman AR, Millington GWM. Obesity and the skin. Br J Dermatol. 2011;165(4):743-750. doi:10.1111/j.1365-2133.2011.10393.x. [DOI]
Guran T, Turan S, Akcay T, Bereket A. Significance of acanthosis nigricans in childhood obesity. J Paediatr Child Health. 2008;44(6):338-341. doi:10.1111/j.1440-1754.2007.01272.x. [DOI]
Brickman WJ, Huang J, Silverman BL, Metzger BE. Acanthosis nigricans identifies youth at high risk for metabolic abnormalities. J Pediatr. 2010;156(1):87-92. doi:10.1016/j.jpeds.2009.07.011. [DOI]
Aswani R, Lochow A, Dementieva Y, Lund VA, Elitsur Y. Acanthosis nigricans as a clinical marker to detect insulin resistance in Caucasian children from West Virginia. Clin Pediatr (Phila). 2011;50(11):1057-1061. doi:10.1177/0009922811414288. [DOI]
Silverberg JI, Kleiman E, Lev-Tov H, Silverberg NB, Durkin HG, Joks R, et al. Association between obesity and atopic dermatitis in childhood: a case-control study. J Allergy Clin Immunol. 2011;127(5):1180-1186.e1. doi:10.1016/j.jaci.2011.01.063. [DOI]
Kluczynik CEN, Mariz LS, Souza LCF, Solano GB, Albuquerque FC, Medeiros CCM. Acanthosis nigricans and insulin resistance in overweight children and adolescents. An Bras Dermatol. 2012;87(4):531-537. doi:10.1590/S0365-05962012000400002. [DOI]
Mirmirani P, Carpenter DM. Skin disorders associated with obesity in children and adolescents: a population-based study. Pediatr Dermatol. 2014;31(2):183-190. doi:10.1111/pde.12271. [DOI]
Ng HY, Young JHM, Huen KF, Chan LTW. Acanthosis nigricans in obese Chinese children. Hong Kong Med J. 2014;20(4):290-296. doi:10.12809/hkmj134071. [DOI]
Dash M, Jena AK, Panda M, Patro N. Prospective clinical study of the skin markers in childhood obesity-an emerging pandemic. Pediatric Review: International Journal of Pediatric Research. 2016;3(6):462-466. doi:10.17511/ijpr.2016.i06.15. [DOI]
Gupta M. Cutaneous manifestations of obesity in children: a prospective study. Indian J Paediatr Dermatol. 2017;18(1):28-30. doi:10.4103/2319-7250.193004. [DOI]
Palhares HMC, Zaidan PC, Dib FCM, Silva AP, Resende DCS, Borges MF. Association between acanthosis nigricans and other cardiometabolic risk factors in children and adolescents with overweight and obesity. Rev Paul Pediatr. 2018;36(3):301-308. doi:10.1590/1984-0462/;2018;36;3;00017. [DOI]
Nithun TM, Ranugha PSS, Betkerur JB, Shastry V. Association of acanthosis nigricans and insulin resistance in Indian children and youth: a HOMA2-IR-based cross-sectional study. Indian Dermatol Online J. 2019;10(3):272-278. doi:10.4103/idoj.IDOJ_303_18. [DOI]
Andersen PL, Kromann C, Fonvig CE, Riis PT, Jemec GBE, Holm JC. Hidradenitis suppurativa in a cohort of overweight and obese children and adolescents. Int J Dermatol. 2020;59(1):47-51. doi:10.1111/ijd.14639. [DOI]
Jorgensen AHR, Aarestrup J, Baker JL, Thomsen SF. Association of birth weight, childhood body mass index, and height with risk of hidradenitis suppurativa. JAMA Dermatol. 2020;156(7):746-753. doi:10.1001/jamadermatol.2020.1047. [DOI]
Lopez-Alvarenga JC, Chittoor G, Paul SFD, Puppala S, Farook VS, Fowler SP, et al. Acanthosis nigricans as a composite marker of cardiometabolic risk and its complex association with obesity and insulin resistance in Mexican American children. PLoS One. 2020;15(10):e0240467. doi:10.1371/journal.pone.0240467. [DOI]
Liy-Wong C, Kim M, Kirkorian AY, Eichenfield LF, Ambarus CA, Friedlander SF, et al. Hidradenitis suppurativa in the pediatric population: an international, multicenter, retrospective, cross-sectional study of 481 pediatric patients. JAMA Dermatol. 2021;157(4):385-391. doi:10.1001/jamadermatol.2020.5435. [DOI]
Sunkwad A, Mahajan S. Cutaneous manifestations in overweight and obese children and adolescent. Int J Contemp Pediatr. 2021;8(10):1662-1666. doi:10.18203/2349-3291.ijcp20213726. [DOI]
Guven M, Anik A, Unuvar T, Ilgun Gurel D, Sendur N. Cutaneous manifestations of obesity in Turkish children: a comparative study. Pediatr Dermatol. 2022;39(4):513-519. doi:10.1111/pde.14978. [DOI]
Hasse L, Jamiolkowski D, Reschke F, Kapitzke K, Weiskorn J, Kordonouri O, et al. Pediatric obesity and skin disease: cutaneous findings and associated quality-of-life impairments in 103 children and adolescents with obesity. Endocr Connect. 2023;12(9):e230235. doi:10.1530/EC-23-0235. [DOI]
Hasse L, Jamiolkowski D, Reschke F, Kapitzke K, Weiskorn J, Kordonouri O, et al. Erratum: Pediatric obesity and skin disease: cutaneous findings and associated quality-of-life impairments in 103 children and adolescents with obesity. Endocr Connect. 2024;13(11):x230235. doi:10.1530/EC-23-0235e. [DOI]
Kus MM, Mulayim MK, Kus C, Doganer A, Ozturk P, Temiz F, et al. Dermatoses in overweight and obese children and their relationship with insulin and skin color. J Cosmet Dermatol. 2023;22(10):2791-2798. doi:10.1111/jocd.15773. [DOI]
Greene RK, Gangidi S, Zhao R, Nelson JM, Harms K, Nakamura M. The relationship between acrochordons, obesity, and metabolic syndrome in the pediatric population: a retrospective cohort study. Pediatr Dermatol. 2024;41(4):660-666. doi:10.1111/pde.15639. [DOI]
Kim SR, Koh SJ, Park H. Childhood obesity, weight change, and pediatric immune-mediated skin diseases. J Invest Dermatol. 2024;144(9):1975-1984.e10. doi:10.1016/j.jid.2024.01.037. [DOI]
Thomas AW, Bhatia A, Sharma M. A cross-sectional study of cutaneous manifestations in overweight and obese children. Indian J Paediatr Dermatol. 2024;25(1):27-30. doi:10.4103/ijpd.ijpd_29_23. [DOI]
Das RR, Mangaraj M, Nayak S, Satapathy AK, Mahapatro S. Acanthosis nigricans and its association with cardio-metabolic risk factors in children with overweight/obesity: a school-based cross-sectional study. J Family Med Prim Care. 2025;14(1):254-258. doi:10.4103/jfmpc.jfmpc_866_24. [DOI]
Epstein S, Shah SD. Evaluating the cutaneous manifestations and associated comorbidities of childhood obesity. Pediatr Dermatol. 2025;42(4):800-802. doi:10.1111/pde.15887. [DOI]
Mohan A, Abdul Samad K, Nair SP. A cross sectional study of cutaneous manifestations in obese children in a tertiary care center. Indian J Paediatr Dermatol. 2025;26(1):10-15. doi:10.4103/ijpd.ijpd_174_24. [DOI]
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