The interplay between paediatric atopic dermatitis and neurodevelopmental disorders: Emerging evidence, mechanistic insights and clinical implications

Atopic dermatitis (AD), the most common chronic inflammatory skin disease in children, is increasingly recognized as a systemic condition extending beyond the skin. Mounting evidence links paediatric AD with neurodevelopmental disorders (NDDs), particularly attention-deficit/hyperactivity disorder (ADHD), suggesting shared inflammatory and neuroimmune pathways. Epidemiologic studies indicate that up to one quarter of affected children exhibit comorbid NDDs, highlighting a clinically significant intersection between cutaneous and neural development. Mechanistic hypotheses point to chronic immune activation, cytokine-driven neuroinflammation, disruption of the blood–brain barrier, and shared genetic or epigenetic susceptibilities. These processes may alter neuronal connectivity and neurochemical balance during critical periods of brain maturation. However, direct evidence from paediatric cases validating these pathways remains limited. This review integrates recent epidemiological, experimental, and translational data to contextualize the emerging concept of a “skin–brain axis” in AD. It emphasizes advances in cutaneous immunology and neuroinflammatory research, identifies key mechanistic gaps, and proposes priorities for future investigation. Reframing paediatric AD as a systemic inflammatory disorder with neurodevelopmental implications may inform earlier recognition, preventive strategies, and holistic care approaches for affected children.