Atopic dermatitis and psychological disorders in children and adolescents: a systematic review on comorbidities and mechanism.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous lesions and intense pruritus. Its increasing global prevalence poses substantial physical and psychosocial challenges for children and adolescents, particularly adolescents in the developmental stage of identity formation. Given the paucity of exclusive adolescent studies, this review focuses on adolescents while integrating evidence from child-adolescent mixed samples to synthesize comorbidity patterns and mechanisms. METHODS: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Three electronic databases (PubMed, CNKI and PsycINFO) were searched to identify relevant studies published from the inception of each database to October 1st, 2025. Snowball search was performed by reviewing references of included studies and relevant systematic reviews/meta-analyses to avoid missing eligible literature. 66 studies were included in total, with 36 epidemiological studies summarized. Among the 36 studies, 9 (25.0%) focused exclusively on adolescents (10–19 years old), and 27 (75.0%) were mixed-age studies including children (≤9 years) and adolescents. These studies focused on the association between AD and psychiatric conditions, covering various psychiatric comorbidities including anxiety, depression, sleep disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and suicide-related behaviors. RESULTS: Epidemiological evidence generally suggests that adolescents with AD are at an elevated risk of multiple psychiatric conditions, including depression, anxiety, sleep disturbances, suicide-related behaviors, and ASD. However, findings are heterogeneous for ADHD and schizophrenia, with some studies failing to confirm these associations. Proposed mechanisms for these associations include shared genetic susceptibilities, immune-inflammatory dysregulation, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, psychosocial stressors, and exposure to environmental allergens. CONCLUSIONS: Children and adolescents with AD appear vulnerable to a range of psychiatric comorbidities, though evidence heterogeneity and conflicting findings (particularly for ADHD) highlight the need for caution in interpretation. Future research should focus on clarifying inconsistent associations and elucidating the biological and psychosocial pathways linking AD to psychiatric disorders, to inform targeted prevention and intervention strategies. CLINICAL TRIAL NUMBER: Not applicable.