Children with severe atopic dermatitis show unexpected growth patterns, study finds

A global study reveals that children aged five to 11 with difficult-to-control atopic dermatitis are often shorter and heavier than expected, raising questions about the systemic effects of the disease and its treatments.

Children aged five to 11 with harder-to-control atopic dermatitis appear to be shorter than expected for their age while also tending to weigh more, according to a newly published analysis from the global PEDISTAD registry. The paper, published online in Pediatric Dermatology on 18 August 2026, examined enrolment data from 1,329 children younger than 12 with moderate-to-severe disease and compared their measurements with US Centers for Disease Control and Prevention growth percentiles. (onlinelibrary.wiley.com)

The clearest divergence showed up in the older children. Among those aged five to under 12, 72% of boys and 53% of girls were below the 50th percentile for height, while 56% of boys and 52% of girls were above the 50th percentile for weight. That translated into body mass index values above the median in about seven in 10 children in that age band. By contrast, the pattern was far less marked in younger children: among those aged under five, height was above the 50th percentile in 59% of girls and 52% of boys, while weight was above it in 50% and 42% respectively. (onlinelibrary.wiley.com)

The findings bring a peer-reviewed endpoint to work that first drew attention as a prize-winning poster at the 2024 American Academy of Dermatology meeting. Dermatology Times reported then that the cohort’s mean age was 5.98 years and that 53.2% were boys; it also described a racially mixed population that was 59.0% White, 24.3% Asian, 9.9% Black, 1.3% Indigenous and 5.5% Other. All were children whose eczema had been inadequately controlled by topical treatment and who were eligible for systemic medicines. One point did shift between the meeting coverage and the journal paper: an MDedge conference report put the study population at 1,326, whereas the published paper, PubMed record and other later reports give 1,329. (dermatologytimes.com)

The new paper is more cautious than some secondary coverage about why this might be happening. It records a heavy disease burden – 35.1% of the children had sleep disturbed every night, 90% were using topical treatments, 57.9% were on systemic treatment and 16% were receiving dupilumab – yet the authors said their exploratory analyses did not show a direct association between growth measures and itch scores, sleep disruption, current or previous topical or oral corticosteroid use, or common atopic comorbidities such as asthma, food allergy and allergic rhinitis. Dermatology Times later boiled that down to a growth signal occurring “without clear links to itch, sleep loss, steroids, or comorbid atopy.” (onlinelibrary.wiley.com)

Amy Paller, the study’s first author and chair of dermatology at Northwestern University, struck the same note of uncertainty when the data were presented in 2024. MDedge reported that she was “not really surprised by the reduction in linear growth”, given longstanding concerns about inflammation, poor sleep and steroid exposure. What unsettled investigators more, she said, was the weight pattern: she was “a bit surprised by the increase in weight and body mass index”. (mdedge.com)

That broader interpretation has been echoed by other dermatologists. Adam Friedman of George Washington University, commenting to MDedge, argued that atopic dermatitis should be thought of as a systemic inflammatory disease rather than a disorder confined to the skin. The PEDISTAD paper itself floats several possible contributors to shorter stature or heavier weight – including longer disease duration, reduced physical activity, restrictive diets and treatment effects – but stresses that the registry design cannot prove which, if any, are responsible. (mdedge.com)

There are also important methodological limits. The authors compared an international cohort with US CDC growth curves even though only 36.5% of the children came from North America. The analysis was cross-sectional, based on measurements taken at enrolment, so it cannot show whether individual children fell behind and later caught up. It also lacked information on parental height, dietary restriction and other genetic influences that might help explain growth differences. The journal paper says the research was sponsored by Sanofi and Regeneron, which also funded medical writing support. (onlinelibrary.wiley.com)

What happens next may matter more than the baseline snapshot. Paller told EMJ Reviews that this was “the first real-world study through a registry”, and said the expansion of newer, safer medicines in children aged six to 11 makes it important to see whether better control of inflammation and sleep can translate into better linear growth. The PEDISTAD paper says the study will follow participants for up to 10 years, and it points to earlier phase 3 dupilumab data suggesting that some children below lower height percentiles can gain ground after treatment, with a higher share achieving at least a five-point rise in height percentile by 16 weeks and further improvement over a year. (emjreviews.com)