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Abstract
Childhood eczema or atopic dermatitis (AD) is a distressing disease associated with pruritus, sleep disturbance, impaired quality of life and Staphylococcus aureus isolation. The pathophysiology of AD is complex and various seromarkers of immunity are involved. We investigated if anti-staphylococcal enterotoxin IgE (anti-SE), selected seromarkers of T regulatory (Treg), T helper (Th) and antigen-presenting cells (APC) are associated with clinical signs of disease severity and quality of life. Disease severity was assessed with the Scoring Atopic Dermatitis (SCORAD) index, and quality of life with the Children’s Dermatology Life Quality Index (CDLQI) in AD patients ≤18 years old. Concentrations of anti-staphylococcus enterotoxin A and B immunoglobulin E (anti-SEA and anti-SEB), selected Treg/Th/APC chemokines, skin hydration and transepidermal water loss (TEWL) were measured in these patients. Forty patients with AD [median (interquartile range) age of 13.1 (7.9) years) were recruited. Backward stepwise linear regression (controlling for age, personal allergic rhinitis and asthma, and other blood markers) showed the serum anti-SEB level was positively associated with S. aureus and S. epidermidis isolations, objective SCORAD, clinical signs and CDLQI. TNF-α (a Th1 cytokine) was positively associated with objective SCORAD (B = 4.935, p = 0.010), TGF-β (a Treg cytokine) negatively with disease extent (B = −0.015, p = 0.001), IL-18 (an APC cytokine) positively with disease extent (B = 0.438, p = 0.001) and with TEWL (B = 0.040, p = 0.010), and IL-23 (an APC cytokine) negatively with disease extent (B = −2.812, p = 0.006) and positively with pruritus (B = 0.387, p = 0.007). Conclusions: Blood levels of anti-SEB, Th1, Treg and APC cytokines are correlated with various clinical signs of AD. AD is a systemic immunologic disease involving Staphylococcus aureus, cellular, humoral, cytokine and chemokine pathophysiology.
Highlights
Eczema or atopic dermatitis (AD) is a distressing disease associated with pruritus, sleep disturbance and impaired quality of life [1,2]
Thirty-six (90%) and seventeen (43%) patients were found to have skin colonized with S. aureus or S. epidermidis, and sixteen of these patients were colonized with both bacteria
Activation of T lymphocytes, dendritic cells, macrophages, keratocytes, mast cells, and eosinophils is characteristic of AD skin inflammatory responses
Summary
Eczema or atopic dermatitis (AD) is a distressing disease associated with pruritus, sleep disturbance and impaired quality of life [1,2]. There is a known hereditary component of the disease, and it is more common in atopic families [1]. Criteria that enable a doctor to diagnose it include the typical appearance and distribution of the rash in a patient with a personal or family history of atopy [1,3,4]. AD is a challenge for modern medicine because it is prevalent, severely affects the quality of life of patients and their families, and causes high socioeconomic costs [5]. While initial studies suggested a Th2 deviation as the primary reason for the disease, numerous studies addressed a genetically predetermined impaired epidermal barrier as the leading cause in a subgroup of patients. Trigger factors have been expanded beyond classical Th2 allergens such as pollen or house dust mites to microbial products as well as self-antigens
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