The aim of this study:

1. Evaluate the presence of body dysmorphic disorder in children with dermatological diseases compared to healthy controls.
2. Assess the effect of these skin diseases on the quality of life in those children.

Skin diseases are the fourth leading cause of non-fatal disease in humans. Worldwide, between 30% and 70% of individuals are affected. Most dermatological conditions have an impact on patients' social, physical, and emotional well-being, as well as their friends, partners, and families.

The psychological impact of skin diseases is an issue of increasing concern worldwide but little research or exploration in this area has been undertaken.Pediatric psychodermatology is an emerging field that is uniquely tailored to the developmental, emotional, and psychosocial needs of children with psychocutaneous conditions.

Body dysmorphic disorder (BDD) is a psychiatric condition defined as a preoccupation with a perceived defect or flaw in one's physical appearance when, in fact, they appear normal. BDD falls under the spectrum of obsessive-compulsive and related disorders.

Often under recognized, BDD is a prevalent disorder characterized by an all-consuming focus on perceived physical imperfections, leading to distressing repetitive actions and, at times, suicidal behavior and ideation. Individuals with BDD often seek unnecessary surgical interventions.

The affected patients visit dermatology and plastic surgery clinics to repair their perceived defects. Understanding BDD's features and diagnostic criteria across all healthcare specialties helps increase awareness and recognition of the condition.

Body dysmorphic disorder is commonly first encountered by nonpsychiatric physicians. It is estimated to range from 0.7% to 2.4% in general clinics met diagnostic criteria for BDD, increasing to 9% to 12% in general dermatology clinics, 8% to 37% in cosmetic dermatology clinics, 2.9% to 53.6% in cosmetic surgery clinics and 14.1% among patients with chronic skin disease. These findings highlight the strong link between skin disorders and BDD, supporting the importance of studying this link specially in children and adolescents.

Most research on BDD focuses on adolescents and adults, however childhood- BDD remain underestimated because appearance concerns may be misinterpreted as normal developmental features. Children with early symptoms may hide their worries or struggle to express them, contributing to diagnostic delay.

Chronic pediatric dermatological diseases including atopic dermatitis, psoriasis, vitiligo, alopecia areata, and acne vulgaris are associated with a significant psychological burden. Commonly reported psychiatric manifestations include anxiety, depression, low self-esteem, social withdrawal, and impaired quality of life. More severe comorbidities such as ADHD, obsessive-compulsive disorder, bipolar disorder, psychotic disorders, substance use, eating disorders, and suicidal ideation have also been described.

Screening for BDD by dermatologists is of paramount importance. Dermatologists should ask patients with minimal or non-existing defects about how much time each day they spend in thinking about their defects and how much such concerns cause distress or interfere with functioning. Patients who are concerned and preoccupied with perceived defects, spending at least one hour thinking about them and their concerns lead to functioning impairment or clinically significant distress should be considered for BDD diagnosis.

Given the emerging evidence linking skin diseases with body image disturbances in young populations , It is essential to investigate the prevalence, associated factors, and psychosocial impact of BDD among children with skin disorders. This supports the development of early screening programs and collaborative models between dermatology and child mental health services.Early recognition and intervention may significantly improve both psychological well-being and dermatological treatment outcomes in affected children.

Inclusion Criteria:

• The study will include 250 children of both sexes aged from six up to less than 18 years presenting with various chronic skin diseases, diagnosed clinically, by dermoscopy and by biopsy if needed, and age and sex matched healthy controls.
• Ability of the child and caregiver to understand and respond to the questionnaires.

Exclusion Criteria:

• Children with diagnosed psychiatric disorders other than BDD (e.g., severe depression, autism spectrum disorder).
• Children with chronic systemic illness affecting body image or any other debilitating acute , chronic illness or surgical problems e.g.: short stature, hypothyroidism, osteochondral defects and obesity.

The study will include 250 patients with dermatological diseases and 250 age and sex matched healthy controls. From Dermatology outpatient clinics, Sohag University Hospitals, Faculty of Medicine Sohag University.