Atopic dermatitis in adolescents: Clinical and psychosocial challenges – A narrative review

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by pruritus, epidermal barrier dysfunction, and immune dysregulation. Although frequently considered a disorder of infancy and early childhood, longitudinal evidence demonstrates that a substantial proportion of affected individuals experience persistent or relapsing disease through adolescence, a life stage defined by the World Health Organization as the period between 10–19 years of age. The clinical phenotype in adolescents differs from that in younger children: Lesions become more lichenified and flexural, facial and hand involvement acquires particular psychosocial significance, and hidden sites such as the genitalia are frequently underreported. Adolescents are also uniquely vulnerable to the psychosocial sequelae of chronic skin disease, including depression, anxiety, impaired body image, disrupted intimate relationships, and academic underperformance that extend beyond what objective disease severity might predict. This narrative review synthesizes current evidence on the epidemiology, clinical manifestations, diagnostic considerations (including differential diagnosis and the role of patch testing), comorbidities, and management of AD specifically in adolescents, with emphasis on their distinct clinical and developmental context. Special attention is given to comorbidities that have been underemphasized in this age group, including coexisting acne vulgaris, obesity and metabolic syndrome, sleep disturbance, and infectious complications, particularly eczema herpeticum and Malassezia -associated disease. Validated clinical and quality-of-life outcome measures applicable to adolescents are reviewed, and an evidence-based, step-up therapeutic algorithm is presented. The review emphasizes that psychosocial care should be embedded in routine dermatological consultations rather than siloed as a specialist service, and that many adolescents derive meaningful benefit from clinicians who listen, validate their experience, and proactively address concerns about treatment and disease course. Specific cultural and socioeconomic challenges faced in India, including topical corticosteroid phobia amplified by social media, widespread use of traditional remedies, limited access to advanced therapies, and social stigma, are discussed with practical management guidance. An urgent need for India-specific epidemiological and therapeutic research in adolescent AD is identified.