Atopic dermatitis patients show increases in serum C-reactive protein levels, correlating with skin disease activity

Anjali S Vekaria,Mark G Lebwohl,Ariel Israel,Lauren Bonomo,Emma Guttman-Yassky,Ahmad I Aleisa,Patrick M Brunner

doi:10.12688/f1000research.12422.1

Anjali S Vekaria, Mark G Lebwohl + Show 5 more

Open Access

https://doi.org/10.12688/f1000research.12422.1

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Abstract

Background: Atopic dermatitis (AD), the most common chronic inflammatory skin disease, is evolving as a systemic disease, and associated systemic inflammation is possibly linked to increases in cardiovascular disease. Methods: We assessed levels of the inflammatory marker CRP in 59 patients with moderate-to-severe AD compared to matched healthy controls, and to determine correlation with skin disease severity. Clinical severity was measured using SCORing of Atopic Dermatitis (SCORAD) and body surface area (BSA). Control subjects (n=118), matched by age, gender, smoking status and ethnicity, were obtained from the National Health and Nutrition Survey (NHANES). Results: AD patients had significantly increased serum CRP levels compared to controls (0.7±1.0 vs. 0.4±0.7mg/dl; p=0.001). CRP levels were significantly correlated with both SCORAD (r=0.427, p=0.0008) and BSA (r=0.407, p=0.0015). IgE levels in AD were highly elevated (median 2903U/ml, IQR [234,10655]), but only weakly correlated with SCORAD (r=0.282, p=0.0427) and BSA (r=0.382, p=0.0052), but not with CRP levels. AD patients also showed increased LDH levels, but without significant correlations with disease severity (SCORAD, BSA) or CRP. Conclusions: Our study strongly supports CRP as a marker for disease severity in moderate-to-severe AD patients, further demonstrating its chronic systemic nature.

Highlights

Atopic dermatitis (AD), the most common chronic inflammatory skin disease, frequently starts during infancy, and in adults it has usually been present for several decades[1]
There were no significant differences between demographic data of AD patients and controls, blood lipids, body mass index (BMI), or smoking status (Table 1)
This study is the first to demonstrate a correlation of AD disease severity with CRP levels in moderate-to-severe adult AD patients with decades of chronic disease activity, independent of co-existence of asthma

Summary

Introduction

Atopic dermatitis (AD), the most common chronic inflammatory skin disease, frequently starts during infancy, and in adults it has usually been present for several decades[1]. C-reactive protein/CRP, an acute phase reactant reflecting systemic inflammation, has been suggested as potential biomarker for cardiovascular disease[9]. One recent study suggests that CRP levels are increased in adult chronic AD patients vs matched controls[12], but it remains to be determined whether CRP could serve as a marker for disease severity. Studies in children and adolescents with active AD did not show increases in overall CRP levels compared to controls[13], and elevated CRP levels early in life were claimed to have a protective role against the development of AD14 and allergic sensitization[15], suggesting that chronic lowgrade inflammation in infants might provide some protection from allergen sensitization. In order to better clarify the potential role of CRP as disease biomarker, we sought to investigate CRP serum levels in moderate-to-severe adult AD patients in relation to skin disease severity

Methods

Results

Discussion

Silverberg JI

13. Silverberg JI