الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
sexes. It was formally recognized as a global epidemic by the World Health Organization (WHO), who defines obesity as an excess in fat mass great enough to increase the risk of morbidity, altered physical, psychological, or social well-being and/or mortality. Obesity is a disorder with multiple causes; environmental factors, lifestyle and behavioral factors and genetic factors; a polygenic or common genetic obesity, monogenic obesity disorders and a syndromic obesity. Obesity in children associated with a large number of debilitating and life-threatening disorders leading to impairment in psychosocial health and consequent social health problems as well leading to numerous multisystem medical complications which include skin complications. Moreover, Obesity has economic burdens for both the individual and society.
Leptin is one of the most important adipocytokines, serum leptin levels are positively correlated with the amount of body fat. The leptin resistance could be the result of either a defect in the transport of leptin across the blood brain barrier or impairments at a number of levels in intracellular signaling mechanisms downstream of leptin. Moreover, increased food intake and associated adiposity promote cellular leptin resistance in diet induced obesity. Insulin resistance (IR) could be a consequence of obesity due to obesity associated chronic inflammation, hyperinsulinemia, lipotoxicity, hypoxia and oxidative stress. IR associated with obesity is mainly a reversible condition which can be ameliorated through exercise and caloric restriction, added to reduce added sugar consumption and/or low glycemic index foods.
Obesity is implicated in a wide spectrum of dermatologic disorders including skin disorders associated with obesity as acanthosis nigricans, skin tags (acrochordon), striae distensae (stretch marks), plantar hyperkeratosis and keratosis pilaris, and skin disorders exacerbated by obesity as atopic dermatitis, psoriasis and skin infections. Children are often considered the priority population for intervention strategies as early identification of childhood obesity and education about modifiable factors with reduction of body weight may have a great effect on some skin disorders management. In obesity-associated acanthosis nigricans; treatment with drastically reduced caloric intake can decrease weight and ameliorate the insulin resistant state resulting in resolution of it. Moreover, weight loss is an important approach for the prevention and treatment of plantar hyperkeratosis and atopic dermatitis in children. In psoriasis; the progressive weight loss can produce significant improvements in therapy outcome and severity by reduction the inflammatory state.
The aim of the present study was to study skin disorders associated with overweight and obesity in children in Alexandria, to detect the presence of the most frequent skin disorders among the participants and to investigate the association between different biochemical parameters (serum leptin hormone level and insulin resistance level) in different weight categories and occurrence of skin disorders. Also to determine the relation between the grades of BMI and associated change in the leptin hormone level and to determine the relation between the grades of BMI and the degree of skin disorders which is can be diagnosed clinically.
This study was conducted according to the guidelines of medical research involving human subjects and was approved by ethics committee of High Institute of Public Health, Alexandria University, Egypt. Verbal Consent was obtained from patients‟ legal care takers after informing them about the study purpose and they had the right to participate or not in the study.
A case-control study with a systematic random sampling technique was carried out on 765 participants aged 7-15 years with variety of skin disorders. They classified according to their BMI percentile for age into 3 groups (normal weight, overweight, obese children). Each group contains 255 children. A pre-structured interviewing questionnaire was used to collect data about personal characteristics (gender, age, child work) and family history of obesity, and dietary pattern including number of daily meals, main meal, intake of snacks and their types. Body weight and height were performed in for all children then Body mass index (BMI) was calculated. A complete dermatological examination was carried out for all participants and severity of psoriasis was quantified using the Psoriasis Area and Severity Index (PASI). Moreover, atopic dermatitis was diagnosed clinically according to the diagnostic criteria for atopic dermatitis of the UK working party. A total volume of 5 ml of venous blood was drawn from each child to determine leptin level (ng/ml), fasting plasma glucose level (FPG) (mmol/L), fasting plasma insulin (FPI) (μU/ml) and insulin resistance index (IRI) that was done by using the Homeostatic Model Assessment index (HOMA-IR).
Statistical analysis was conducted using PC with the software: IBM SPSS software (Statistical Package for the Social Sciences; SPSS Armonk, NY: IBM Corp) version 20.0. Statistical significance was set at (P)-values ≤ 0.05 and ≤ 0.001 highly significant. Data was presented tabular and mathematically using the mean, standard deviation (SD), minimum (Min) and maximum (Max). Data were analyzed using Chi squared test for categorical data. Monte Carlo (MCp) and Fisher exact (FEp) techniques were used as a correction for Chi-square test when more than 20% of the cells have expected count less than 5 for comparing between the three groups. Analysis of variance (ANOVA) was used to test normally distributed quantitative variables, to compare between more than two groups. Kruskal-Wallis test for comparing between more than 2 studied groups, for abnormally distributed quantitative variables.
from data of the present study, the following can be concluded:
Parental educational level of obese and overweight children was lower than normal body weight children.
A higher percent of obese and overweight children had family history of obesity than normal body weight children.
Dinner was the most prevalent main meal among overweight and obese children.
Sweets and soda were the most common snacks consumed by overweight and obese children.
The most frequent skin disorders encountered among participants were skin tags followed by stretch marks, acanthosis nigricans and acne.
Summary, Conclusions & Recommendations
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The greater the BMI the more the prevalence of some skin disorders as skin tags, stretch marks, acanthosis nigricans, psoriasis, atopic dermatitis, fungal and bacterial skin infections, plantar hyperkeratosis, keratosis pilaris and folliculitis.
Overweight and obese children had higher levels of leptin hormone, fasting plasma insulin, fasting plasma glucose, HOMA-IR than normal body weight children.
Almost all obese and two-third of overweight children had insulin resistance.
As BMI increased the severity of skin disorder increased as in skin tags and psoriasis.
Leptin hormone was higher among obese and overweight children with psoriasis and skin tags than other skin disorders.
HOMA-IR level was higher among obese and overweight children with acanthosis nigricans and skin tags than other skin disorders.
from the results of the study, the following can be recommended:
Early attention for obese and overweight children having skin problems like acanthosis nigricans and skin tags may point to an underlying systemic disease like diabetes, unlike other skin disorders such as plantar hyperkeratosis, could serve as markers of obesity and its severity.
Weight reduction program must be done by qualified nutritionists to obese children to reduce incidence of diseases in such cases.
More health and nutritional education sessions for parents and children about obesity and its complications and how to prevent them.
Laboratory investigation including serum leptin level and insulin resistance for obese and overweight children could help in predicting some chronic diseases as diabetes.
Dermatologists must work with nutritional specialists to reduce the detrimental effects of obesity on the skin.