The Interplay Between Pediatric Atopic Dermatitis and Neurodevelopmental Disorders: Emerging Evidence, Mechanistic Insights, and Clinical Implications

Atopic dermatitis (AD) is a common chronic inflammatory skin disease in children and is increasingly recognized as a systemic disorder with potential consequences beyond the skin. Growing evidence links pediatric AD to neurodevelopmental disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but the mechanisms and clinical implications remain incompletely understood. Systemic and neuroimmune inflammation, altered T-helper-cell and cytokine signaling, and genetic and epigenetic susceptibility may contribute to this association. Sleep disruption and psychosocial stress represent additional potential pathways linking skin inflammation with neurodevelopment. Stronger associations have been reported in children with severe or early-onset AD, multiple atopic comorbidities, and persistent sleep disturbance, highlighting the importance of disease heterogeneity. This narrative review integrates epidemiologic evidence and proposed mechanisms to examine the skin–brain axis in pediatric AD, with particular attention to high-risk phenotypes and implications for developmental surveillance and multidisciplinary management. Although current evidence supports an association, causality remains uncertain. Prospective studies integrating AD phenotypes, biomarkers, and neurodevelopmental assessments are needed to clarify these relationships and determine whether early effective AD treatment can modify long-term neurodevelopmental trajectories.