Adverse Childhood Experiences and Pediatric Dermatology: Implications for Care, Equity, and Research.

Adverse childhood experiences (ACEs) are increasingly recognized as important determinants of lifelong physical and mental health through mechanisms involving chronic stress, immune dysregulation, and inflammation. Although ACEs have been associated with numerous chronic medical conditions, their relevance to pediatric dermatology has received comparatively little attention. Existing evidence directly linking ACEs to dermatologic disease is limited and focuses primarily on atopic dermatitis and psoriasis, while research involving other pediatric skin disorders has largely examined psychosocial stress, trauma, or social drivers of health using heterogeneous frameworks. This fragmented approach limits the ability to compare findings across conditions and to understand how cumulative early-life adversity influences disease onset, severity, treatment response, and quality of life. In this commentary, we review the current evidence connecting ACEs and dermatologic disease, distinguish ACEs from broader social drivers of health, and identify critical gaps in the pediatric dermatology literature. We discuss methodological considerations for incorporating ACE measures into pediatric dermatology research and outline practical, trauma-informed approaches for integrating awareness of early-life adversity into clinical care. Pediatric dermatologists care for children during the developmental period in which ACEs occur and often develop long-term therapeutic relationships, positioning the specialty to advance understanding of how cumulative adversity shapes skin disease trajectories. Greater incorporation of ACE-informed frameworks into research and clinical practice may improve understanding of pediatric skin disease and support more holistic, patient-centered care.