Psychocutaneous Disorders in Pediatric and Adolescent Populations: A Narrative Review

Psychocutaneous disorders (PCDs) in children and adolescents lie at the intersection of dermatology and psychiatry and include primary psychiatric conditions with cutaneous manifestations, dermatologic diseases with psychiatric sequelae, and functional or overlap syndromes. Despite substantial psychosocial burden and chronic morbidity, pediatric PCDs remain under-recognized and inconsistently managed. We conducted a narrative review of PubMed, Embase, PsycINFO, Scopus, and Web of Science (2000-2025), including epidemiologic studies, clinical trials, meta-analyses, and consensus statements addressing prevalence, risk factors, diagnostic tools, and management strategies in pediatric psychodermatology. Available data suggest that 20-30% of youth with chronic skin disease have comorbid psychiatric conditions; trichotillomania and excoriation disorder affect approximately 1-5% of children, and adolescents with acne have a two- to three-fold increased risk of depression. Diagnosis is frequently delayed due to overlapping clinical presentations, limited clinician training, and inconsistent use of validated screening instruments, many of which are better studied in older adolescents than younger children. Behavioral interventions remain first-line for most pediatric PCDs, with pharmacologic therapy reserved for moderate-to-severe or refractory cases; optimized dermatologic management may mitigate secondary psychiatric distress. Early recognition through structured screening, developmentally informed assessment, and attention to family and psychosocial context is needed to improve outcomes. Key gaps include limited pediatric-specific epidemiologic data, insufficient validation of assessment tools in younger populations, and a lack of longitudinal treatment studies, highlighting the need for targeted research to inform care.