Beyond the Skin: An Integrated Biopsychosocial Framework for Childhood Atopic Dermatitis

Atopic dermatitis (AD) is a common chronic inflammatory skin disease in childhood characterized by pruritus, skin barrier dysfunction, and a relapsing–remitting course. Beyond its cutaneous manifestations, AD may substantially affect the psychosocial well-being of children and their families. Objective: To synthesize current evidence on the psychosocial burden of pediatric AD and integrate biopsychosocial and burden-of-disease frameworks into a clinically oriented approach, with particular relevance to pediatric allergy practice. Methods: A narrative review of literature published from January 2013 through May 2026 was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Evidence addressing health-related quality of life, sleep disturbance, emotional and behavioral outcomes, social functioning, treatment-related burden, and caregiver and family burden was synthesized narratively, prioritizing pediatric populations. Results: Pediatric AD is associated with multidimensional burden involving health-related quality of life, sleep, emotional well-being, social functioning, and family life. Physician-assessed disease severity and patient- or family-perceived burden show imperfect correspondence, supporting the complementary use of patient- and caregiver-reported outcomes. Nocturnal pruritus and sleep disruption may contribute to bidirectional interactions among skin symptoms, emotional distress, and family burden. Visible lesions may contribute to stigma and social difficulties, while caregivers may experience sleep loss, stress, treatment burden, and concerns regarding topical corticosteroid use. Current guidance increasingly supports assessment of patient- and family-reported burden alongside objective disease severity. Conclusions: Integrating biopsychosocial and burden-of-disease perspectives may support a more comprehensive approach to pediatric AD. Routine care should include discussion of sleep, emotional well-being, social functioning, and family burden, with further assessment or multidisciplinary support considered when clinically relevant concerns are identified.