Featured Student: Demi Elrod

Demi Elrod is a fifth-year student in the B.A./M.D. program at the University of Missouri-Kansas City. She enjoys crafting, babysitting, and exploring Kansas City's vast food scene in her spare time. Her favorite research subjects are underserved populations and psoriasis treatment developments. She enjoys keeping up with recent publications in dermatology so that she can gain more experience with evaluating the quality and clinical applications of studies. 

Childhood obesity has long been recognized as a contributor to various health conditions, but its role in dermatologic diseases is an evolving area of study. A recent nationwide population-based cohort study from Korea has provided significant insights into the relationship between childhood obesity, weight fluctuations, and the development of early-onset follicular occlusion triad (FOT). This triad includes hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS), all of which involve chronic inflammation and follicular blockage. Understanding this link is crucial for early intervention and management strategies in pediatric dermatology.

The study analyzed data from over two million Korean children who underwent health screenings between 30 to 36 months and 42 to 48 months of age from 2009 to 2020. By tracking changes in body mass index (BMI), researchers aimed to determine whether obesity and weight gain increase the risk of developing FOT. The study identified 1,283 cases of early-onset FOT, including 143 cases of HS, 1,068 cases of AC, and 72 cases of DCS. Obesity at an early age increased the risk of FOT, with children who were obese having a 49% higher likelihood of developing the condition compared to those with a normal weight. The risk was particularly pronounced for HS and AC. Additionally, weight gain was strongly associated with an increased risk of FOT, while weight loss was found to be protective, particularly against HS. Children who transitioned from obesity to a normal weight had a significantly lower risk of developing FOT compared to those who remained obese.

This study has several notable strengths, including its large sample size, longitudinal design, and use of a nationwide health database, all of which enhance the reliability and generalizability of its findings. The study also presents a clear dose-response relationship, showing a progressive trend where increasing BMI correlates with higher FOT risk. However, some limitations exist, such as the lack of genetic and environmental factors in the analysis, the homogeneity of the study population, a relatively short follow-up period, and reliance on BMI as a measure of body composition. These factors suggest that additional research is needed to confirm and expand upon these findings.

The implications of this study are significant for dermatologists, particularly those treating pediatric and adolescent patients. Given the strong association between obesity and FOT, dermatologists should incorporate BMI assessments into routine skin evaluations for children, allowing for early identification and intervention. A multidisciplinary approach involving pediatricians, nutritionists, and endocrinologists may be necessary to develop comprehensive weight management plans for at-risk children. Education is also critical, as dermatologists can play a key role in discussing weight control strategies with parents and caregivers, emphasizing that maintaining a healthy weight can help prevent severe dermatologic conditions. Future research should focus on the biological mechanisms linking obesity to follicular occlusion disorders, investigate these associations in diverse populations, and extend follow-up periods to determine the long-term effects of early childhood obesity on dermatologic health. This study provides compelling evidence that childhood obesity and weight gain significantly increase the risk of early-onset follicular occlusion triad, particularly hidradenitis suppurativa and acne conglobata. More importantly, weight loss appears to be protective, suggesting that early intervention and weight management strategies can play a crucial role in preventing these chronic skin conditions. By integrating weight assessment and management into dermatologic practice, physicians can take proactive steps in reducing the burden of obesity-related dermatologic diseases in children.

Works Cited

Kim, S. R., Koh, S. J., & Park, H. (2025). Association of childhood obesity or weight change with early-onset follicular occlusion triad in children. The British journal of dermatology, 192(3), 430–439. https://doi.org/10.1093/bjd/ljae414