Clinical Course Of Atopic Dermatitis Research Articles

DNA methylation profile and expression of the phyllagrin gene in patients with atopic dermatitis: case-control study

Background. Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, affecting up to 20.0% of children and 2.0–8.0% of adults worldwide. Patients with atopic dermatitis usually have dry skin and itching, they are at higher risk of developing asthma, as well as allergic rhinitis. Features of the clinical course of AD are associated with both interaction of genes and influence of environmental factors. Studying epigenetic mechanisms could provide understanding of the most likely mechanisms by which environmental factors influence gene expression and contribute to the development of AD. The aim of the study is to conduct a comprehensive molecular genetic analysis (assessment of the level of global DNA methylation and expression of the filaggrin gene (FLG) in patients with moderate to severe AD. Material and methods: The case-control study was conducted from January 2022, through June 2022. A total of 32 patients with AD and 6 healthy volunteers were recruited. The level of global DNA methylation in the blood of patients with AD and healthy individuals was assessed. The FLG expression was measured by polymerase chain reaction in the leukocyte fraction of blood. A three-stage cycle is used during PCR. To determine the expression level of the FLG gene, total RNA was isolated, followed by a reverse transcription, amplification, and detection reaction. Results. A hypermethylation of the genome in patients with AD is 2.3 times higher than the methylation of genome in controls (p = 0.003),it was also found that the expression level of the FLG gene (exon 3, position 7–8, and exon 1) in the leukocyte fraction of blood in patients with AD did not significantly differ from the control group (p = 0.41). Conclusion. The current study found that the epigenome of AD patients differs from healthy individuals. The study of pathogenetic mechanisms is the basis for the development of new methods of targeted therapy for this socially significant dermatosis.

Risk Factors of Onset Time and Persistence of Atopic Dermatitis in Children Under Age 5 Years: A Cross-Sectional Study.

Background: The prevalence of atopic dermatitis (AD) is high among children, with development of AD occurring during early childhood in most affected children and some having a chronic disease course. Risk factors for AD in this group remain undefined. Objectives: We analyzed the medical records of children with AD under 5 years of age. We summarized characteristics of the natural course of AD in these children and explored relevant risk factors of AD in infancy and early childhood. Methods: Using a self-developed questionnaire, we investigated 716 children under 5 years of age who were treated for AD at the Dermatology Department of the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China. We conducted the study from October 2021 to September 2022 using telephone and on-site interviews with the children's parents. In parental interviews, data were gathered on neonatal diseases, comorbidities, parental allergy history, maternal history of tobacco and alcohol use, and basic infant information at birth. Some children were tested for serum total immunoglobulin E (IgE) before this study. Results: Neonatal hyperbilirubinemia, neonatal respiratory distress syndrome (NRDS), neonatal infection, and infection during childhood had a significant impact on persistent symptoms and the onset of first symptoms in children with AD (P < 0.05). Allergic diseases as common comorbidities with AD, which had earlier onset of AD related to more obvious disease activity (P < 0.05). Parental history of allergy was also significant in AD (P < 0.05). Serum total iIgE levels in children with AD showed an impact on the clinical course of AD; neonatal hyperbilirubinemia and NRDS may affect IgE levels (P < 0.05). Persistent AD had a significant effect on the physical growth of children with height/length for age Z score ≤3 and weight for height/length Z score ≤3 (P < 0.05). Conclusions: Early adverse events in infants, infection before onset, and susceptibility to infection may affect the onset and clinical course of childhood AD. Serum total IgE levels affect the progression of AD. Persistent AD in childhood may have a slight impact on children's physical growth.

Dermatitis atópica: evaluación de la gravedad y el control de la enfermedad durante la pandemia por COVID-19, y determinación del riesgo cardiovascular en pacientes adultos.

To evaluate the clinical course of atopic dermatitis (AD) in adults during the COVID-19 pandemic and to evaluate their comorbidities and cardiovascular risk. A cross-sectional study was conducted in adults with AD. Severity and control of AD, quality of life, levels of psychological stress, depression and cardiovascular risk were measured. Forty-two patients were included. A decrease in POEM score (11.83 vs 10.12; p=0.004) and PO-SCORAD (37.77 vs 32.49; p= 0.001) was observed in comparison to the scores at pandemic onset. The quality of life correlated with the severity of AD (p<0.0001) while the levels of stress and depression did not show association. Most patients had a low cardiovascular risk. The results suggest a decrease in the current severity of AD compared with severity before pandemic. Quality of life is associated with AD severity.

Clinical Course of Atopic Dermatitis in an Adult with Amyotrophic Lateral Sclerosis: Aetiological Implications of Voluntary Movements and Dermatitis Severity.

is missing (Short communication).

Correlation between lactate dehydrogenase and other laboratory data in patients with atopic dermatitis

Serum lactate dehydrogenase (LDH) can be a clinical marker for assessment of the severity and clinical course of atopic dermatitis (AD). One hundred twenty-eight patients with AD who visited Hirosaki University Hospital were included in this study. There are positive correlations between LDH and IgE, thymus and activation-regulated chemokine (TARC), and eosinophils, while TARC and eosinophils are used in evaluating type I-allergic disease, especially AD, and it is considered that LDH is also useful for evaluation of the severity of AD. Dear Editor, Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic and eczematous lesions.1 AD is associated with elevated serum immunoglobulin (Ig) E levels, specific IgE environmental allergens such as house dust mites, and tissue and peripheral blood eosinophilia.1 Since AD is thought to be a Th2-dominant inflammatory skin disease, especially in the acute phase, thymus and activation-regulated chemokine (TARC) is assumed to be involved in its pathogenesis.2, 3 Lactate dehydrogenase (LDH) is an enzyme present in most cells. Previous studies4 found that elevated serum LDH5 levels are correlated with epidermal cell damage in eczema-associated erythroderma and changes in serum LDH levels can serve as a clinical marker for assessing the severity and clinical course of AD.2 The aim of the present study was to explore the correlation between LDH levels and other laboratory data such as IgE and TARC levels and eosinophil count in patients with AD who visited Hirosaki University Hospital. This study was approved by the Committee of Medical Ethics of Hirosaki University Graduate School of Medicine in Aomori, Japan. This study included 128 patients with AD who visited Hirosaki University Hospital. The following variables were measured: LDH; white blood cell count (neutrophils, lymphocytes, monocytes, eosinophils, and basophils); platelet count; and levels of hemoglobin, TARC, total IgE, and C-reactive protein (CRP). Laboratory data were retrieved from medical records. We investigated the correlation between LDH levels and each laboratory variable using Pearson's test. The Pearson correlation coefficient is a measure of linear correlation between two sets of data. The result always has a value between −1 and 1. The significance level was set at p < .05, and the correlation coefficient ±.4 to ±.7 was considered as correlation. Only total IgE and TARC levels were positively correlated with LDH levels. The correlation coefficient for IgE and LDH levels was .54 (p < .001) (Figure 1A). The correlation coefficient for TARC and LDH levels was .57 (p < .001) (Figure 1B). Eosinophil count was weakly correlated with LDH levels (correlation coefficient, .41; p < .001) (Figure 1C). There was no correlation between TARC and IgE levels, TARC levels and eosinophil count, or IgE levels and eosinophil count. In this study, LDH levels were positively correlated with total IgE levels, TARC levels, and eosinophil count, respectively. Although the correlation between serum IgE levels and disease severity of AD is controversial, a previous study reported that IgE is significantly correlated with EASI score.5 LDH is also considered useful for evaluating disease severity of AD. Since TARC measurement is costly and should be performed only once a month for AD under the Japanese health insurance system, LDH levels and eosinophil count, which are more convenient markers than TARC levels, could be useful in daily clinical evaluation of patients with AD. The limitation of this study is that we did not compare LDH and disease severity of AD directly. So, we cannot conclude yet, and further study is needed. The authors express their gratitude to the study patients, their families, and caregivers, and the investigators who participated in the study; Ms. Haruka Sasaki and Mr. Tatsuto Inoue, Hirosaki University Graduate School of Medicine, in Aomori, Japan, for data analysis. This work was supported in part by Grants-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan (project 20k08684, to S. Minakawa), and by the 2021 Hirosaki University Research Support System. Approval of the research protocol: The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. The study protocol was approved by the Committee of Medical Ethics of Hirosaki University Graduate School of Medicine. Approval No. 2021-025. Informed Consent: All informed consent was obtained from the subjects or guardians. Registry and the Registration No. of the study/trail: The study outline was registered and published in the Japan Registry of Clinical Trials (trial ID no. jRCT1020210017). Animal Studies: N/A. The authors declare no conflict of interest. Management of the peer review process, and all editorial decision making, for this article was undertaken by Editor in Chief, Prof. Manabu Fujimoto.

Изучение роли филаггрина в патогенезе атопического дерматита при беременности

The aim of the research. To study the role of fi laggrin protein in pathogenesis of atopic dermatitis (AD) exacerbation during gestation and to evaluate the effectiveness of the “emollient + topical antipruritic agent” combination therapy. Material and methods. A total of 110 female patients were examined. Among them, 70 were pregnant women with exacerbation of AD, 20 were non-pregnant women with AD exacerbation and 20 were healthy pregnant women. The AD severity was assessed using a point scale – the SCORAD index. Pruritus characterisation was performed using the 5-D Itch Scale by Elman. The serum filaggrin protein level was measured by ELISA. The efficacy of the combination therapy was assessed aft er treatment and included evaluation of AD severity, pruritus, and filaggrin protein levels. Statistical processing of the results was carried out using the Statistica 6.0 application soft ware package. Results. As the result of the study, it was found that the serum filaggrin level was higher in pregnant women with exacerbated AD than in the group of non-pregnant women with exacerbated AD (Mann-Whitney test, p = 0.007) and healthy pregnant women (Mann-Whitney test, p = 0.001). Filaggrin levels decreased after combination therapy. Pruritus evaluation revealed no significant difference between the groups with exacerbated AD (Mann-Whitney test, p = 0.221). After treatment, a significant decrease (Mann-Whitney test, p = 0,001) in itching was noted in the group of pregnant women with AD exacerbation. The mean value of the SCORAD index before and after treatment in the group of pregnant women with AD decreased significantly (Mann-Whitney test, p = 0.001). Conclusion. According to the data obtained, the level of filaggrin in pregnant women with exacerbation of AD is significantly higher than in the control groups. Against the background of combination therapy, there is positive dynamics of the clinical course of AD, as well as a decrease in the level of filaggrin in the blood serum. Further research in this area is required.

Clinical characteristics of atopic dermatitis in children in the hot climate of Uzbekistan

&lt;b&gt;Introduction.&lt;/b&gt; Atopic dermatitis (AD) is a global problem of the 21st century, as the number of people suffering from this disease is steadily increasing, and around the world, about 20% of the population with clinical manifestations of this disease seek medical help. &lt;b&gt;Aim of the study.&lt;/b&gt; Evaluation of the clinical course of AD in children in the hot climate of Uzbekistan. &lt;b&gt;Patients and methods.&lt;/b&gt; 215 patients with atopic dermatitis aged from 1 to 18 years were under observation. The severity of AD was determined using the SCORAD index. &lt;b&gt;Results.&lt;/b&gt; Among 215 patients, the erythematous-squamous form was observed in 63 (29.3%), erythematous-squamous with lichenification - in 47 (21.8%), lichenoid - in 55 (25.6%), exudative - in 34 (15.8%), and pruriginous form of AD - in 16 (7.4%). Most observed patients were adolescents, and the number of boys and girls with AD in this group was similar (49.6% and 50.4%, respectively). In terms of severity, taking into account the SCORAD index, in infancy, most patients had moderate (47.4%) and mild (36.8%) clinical course; in childhood - moderate (56.1%); in adolescence - moderate (40.3%) and severe (33.8%). In infancy, the exudative form was the most prevalent (52.6%). At the age of 2 to 11 years, the erythematous-squamous and lichenoid forms were the most frequently diagnosed (43.8% and 31.6% of cases, respectively). Meanwhile, at the age of 12 to 18 years, the patients were characterized by a different distribution of forms: the erythematous-squamous form with lichenification was observed in 28.1%, the lichenoid form - in 26.6%, and the erythematous-squamous form in 20.8%. &lt;b&gt;Conclusion.&lt;/b&gt; In the present study, we assessed the relative frequency of forms of atopic dermatitis in children of different age groups in the hot climate of Uzbekistan.

Уровень цинка и особенности течения атопического дерматита у детей

Актуальность. В поисках основных патогенетических механизмов атопического дерматита (АД) и улучшения вариантов профилактики и лечения все больше внимания уделяется обеспечению организма ребенка микроэлементами. Особая роль принадлежит цинку, который является одним из самых многофункциональных микроэлементов. Цель: изучить особенности клинического течения АД у детей в зависимости от содержания цинка в сыворотке крови. Материалы и методы. В работе представлены материалы клинического наблюдения, клинико-лабораторного и инструментального обследования 168 детей в возрасте от 7 до 18 лет с АД. Контрольную группу составили 60 практически здоровых детей. Содержание цинка в сыворотке крови определяли методом атомно-абсорбционной спектроскопии на спектрофотометре С-115-М1, согласно инструкциям, прилагаемым к прибору. Результаты. Более половины детей (55,6 %) имели очень низкий уровень цинка — 0,35 ± 0,11 мг/л, еще 22,2 % — крайне низкий (0,12 ± 0,02 мг/л). Отмечен ряд особенностей клинического течения АД: более частые эпизоды острых респираторных вирусных инфекций, преобладание среднетяжелого и тяжелого течения с периорбитальным, периоральным, перианальным дерматитом, дистрофическими изменениями и гиперкератозом ногтей, повышенной ломкостью волос, выраженной сухостью кожи (2,31 ± 0,73 балла против 1,92 ± 0,69 балла; p &lt; 0,01). Выявлены обратные корреляционные связи между концентрацией цинка в сыворотке крови и сухостью кожных покровов (р = 0,001; r = –0,67; t = –2,99), значением индекса SСORAD (р = 0,01; r = –0,49; t = –2,34) и длительностью течения АД (р = 0,001; r = –0,46; t = –2,13). Установлены достоверно более низкие показатели роста (p &lt; 0,05), особенно у детей с очень низким содержанием цинка (0,12 ± 0,02 мг/л). Выводы. У детей с атопическим дерматитом содержание цинка в плазме крови достоверно ниже, чем у здоровых детей. У детей с пониженным содержанием цинка в организме отмечен ряд особенностей клинического течения атопического дерматита (более тяжелое и затяжное течение с периорбитальной и перианальной локализацией, частые респираторные инфекции, выраженные дистрофические изменения придатков кожи, задержка роста).

THE ROLE OF GENETIC POLYMORPHISM OF THE FILAGGRIN PROTEIN WITH ATOPIC MARCH PROGRESSION IN CHILDREN

The aim of the study. To determine the role of genetic polymorphism in the filaggrin gene R501XAA and 2282de4AA at atopic march progression in children. Materials and methods. 111 children aged 3 to 12 years with atopic dermatitis were selected and examined. As a result of genetic testing, it was found that 51 children with atopic dermatitis had polymorphism in the filaggrin gene. These patients were included in the main group. Another 60 children without polymorphism were in the control group. The filaggrin gene polymorphism was determined by examining the buccal epithelium by Dellaporta method. Sensitization to allergens was established on the basis of the specific IgE level. The impact of the disease on the quality of life of children was performed using the CDLQI questionnaire (Children's Dermatology Life Quality Index). Results. In the course of molecular genetics research, R501X mutation was detected in 40 ((78.4 ± 5.76)%) children, 2282del4 polymorphism – in 4 ((7.8 ± 3.76)%) patients, and their combined variant R501X + 2282del4 – in 7 (13%), (7 ± 4.81)% patients. When determining the effect of filaggrin polymorphism on the clinical course of atopic dermatitis, the presence of the associative relationship was established with the following indicators: the early onset of the disease – χ2 = 33.2, mostly severe course – χ2 = 16.2, severe skin dryness – χ2 = 22.6, predominant sensitization to fungi – χ2 = 10.6 and house dust mites – χ2 = 12.2, violation of the skin microbiome – χ2 = 7.8. Conclusions. Early manifestation of atopic dermatitis in children is associated with the filaggrin protein gene polymorphism ((82.4 ± 5.33)%), which determines the risk of progression of the atopic march and the development of bronchial asthma in (38.0 ± 6.8)% of children.

Infantile atopic dermatitis: Serum vitamin D, zinc and TARC levels and their relationship with disease phenotype and severity.

Several markers that influence the clinical course of atopic dermatitis (AD) have been investigated so far. Thymus and activation regulated chemokine (TARC) - a Th2-related cytokine - increase in various atopic diseases. It has been shown that vitamin D affects Treg cells and immune responses. Zinc as an essential trace element for cell-cell interactions, cellular differentiation, and proliferation. However, the effect of these markers on infantile AD and disease severity are mostly unknown. The aim of this study was to investigate the relationship between TARC, vitamin D, zinc levels, and the disease severity in infants with AD. AD patients (n = 160) with age and sex that matched healthy controls (n = 79) were included in the study. The diagnosis of AD was made based on the Hanifin-Rajka criteria. The objective SCORAD index was used for the assessment of disease severity. A total of 160 patients (male 71.9%) with AD were included in the study. The median age of onset of symptoms was 2 (1.0-3.5) months. The lesions initially started on face 76.9%, neck 6.9%, extremities 7.5%, and body 8.8%. Nearly 40% of the patients were found to be atopic. Food allergy was found in 39.4%. The median of objective SCORAD index was 27.5 (17.5-40) in the study group. The TARC levels of AD patients were higher than control group [1803 pg/ml (1006- 3123) vs 709 pg/ml (504-1147), p < 0.001] There was a significant correlation between objective SCORAD scores and TARC values in subjects with AD (r = 0.363, p < 0.001). As the severity of AD increased, vitamin D levels decreased (p for trend 0.015) and TARC values increased (p for trend < 0.001). Serum zinc levels did not change with the severity of the disease. The presence of atopy did not have an influence on serum TARC, zinc, and vitamin D levels. In infants with AD, disease severity is positively related with TARC levels; and inversely proportional to vitamin D levels. TARC levels differ between patients and healthy controls. The presence of atopy has not been shown to affect these markers. © 2021 Codon Publications. Published by Codon Publications.

Effects of Hyperbaric Oxygen Therapy in Children with Severe Atopic Dermatitis.

In the course of atopic dermatitis (AD), the overactivity of the immune system, associated with predominant Th2 lymphocyte responses, is observed, which leads to an increased inflammatory reaction. Cases of a severe course of atopic dermatitis lead to the search for new therapeutic options. The aim of this study was to assess the effects of hyperbaric oxygen therapy (HBOT) treatment for severe cases of AD in children. A total of 15 children with severe AD underwent therapy. The influence of HBOT on the clinical course of AD and immunomodulatory effect of the therapy was analyzed by the SCORAD and objective SCORAD (oSCORAD) scales and by determining the serum concentration of immunological parameters (blood: nTreg lymphocytes, CD4+CD25highCD127-FOXP3+, NKT lymphocytes CD3+, CD16/56+, and serum: total IgE, cytokines IL-4, IL-6, and IL-10, before and after the 30-day treatment cycle). The study showed a significant effect of the therapy on the improvement of the skin condition. In all children, a reduction in the extent and intensity of skin lesions, reduction of redness, swelling, oozing/crusting, scratch marks and skin lichenification after HBOT was observed. Patients also reported a reduction in the intensity of pruritus and an improvement in sleep quality after therapy. In all children, a statistically significant decrease in the serum level of IgE was observed. However, no statistically significant changes in the blood levels of IL-4, IL-6 and IL-10, as well as the percentage of CD4+CD25highCD127−FOXP3+ Treg and NKT lymphocytes, were found. In conclusion, the use of hyperbaric therapy has a positive impact on treatment results in children with a severe course of atopic dermatitis.

PECULIARITIES OF CLINICAL PASSING OF ATOPIC DERMATITIS AND VITAMIN D EXCHANGE IN EARLY CHILDREN

The article is devoted to the study of features of clinical course of atopic dermatitis and vitamin D exchange in young children conducted by us by estimation of severity of atopic dermatitis depending on the value of SCORAD index, determination of 25(OH)D concentration in serum of children by immunochemical method with chemocentric analysis according to the classification approved by experts of the international endocrinological society. In the examination of 188 young children, two groups were formed on the basis of the Lviv City Children's Clinical Hospital. Children from 1 month to 1 year of age with manifestations of atopic dermatitis (n = 120), who were born full-term and had no birth defects, metabolic disorders, severe perinatal CNS lesions formed the main group. The comparison group consisted of 68 healthy young children without chronic diseases. All children had atopic dermatitis in the main group and were classified by severity (depending on the SCORAD index): children with mild severity – 31 (26 %), moderate 47 (39 %), and severe 42 (35 %). As a result of the study, we found a association between the severity of clinical manifestations of atopic dermatitis and the level of vitamin D in the serum. Comparative analysis of the severity of atopic dermatitis, depending on the level of vitamin D in the serum, showed that with severe atopic dermatitis in children of the main group, the level of 25(OH)D was significantly lower compared to its indicators in children with moderate to severe (P &lt; 0.05). Serum vitamin D levels are significantly lower in all forms of atopic dermatitis severity and correlate significantly with the overall SCORAD severity score, erythema intensity, excoriation, itching, and sleep disturbances. The scientific data on the presence of feedback correlation (r = –0,48; P &lt; 0,05) between the development of atopic dermatitis in children and their level of 25(OH)D in serum were added. Our findings suggest that there is a need for a differentiated approach to treating early-stage atopic dermatitis of varying severity, a personalized therapeutic approach to choosing a vitamin D supplementation, given the level of 25(OH)D in the serum.

Lower vitamin D levels in the breast milk is associated with atopic dermatitis in early infancy.

Our previous study showed that the discontinuation of breastfeeding could improve atopic dermatitis (AD) symptoms in exclusively breastfed infants. As vitamins A and D are influential on the immune system, we aimed to analyze the association of vitamin A and D levels in breast milk (BM) with AD. We enrolled two- to four-month-old exclusively breastfed infants. The objective SCORing Atopic Dermatitis (objSCORAD) was evaluated. The lipid layer of BM was extracted and analyzed by liquid chromatography for vitamin A and D levels. Medical charts were reviewed for the clinical course of AD. Forty-five AD patients and 45 healthy controls were enrolled. The objSCORAD was 20.54±1.73 (shown as mean±SEM) in the AD group. The sex, parental atopy history, nutrient intake of mothers, and vitamin A levels in BM were not significantly different between the two groups. The 25-(OH) D3 level in BM was significantly lower in the AD group than in the control group (1.72±0.30 and 3.95±0.64ng/mL, respectively; P=.001). The 25-(OH) D3 level negatively correlated with objSCORAD (P=.003). The only factor that is significantly associated with persistent AD is the objSCORAD in infancy (P=.003) after adjusting for age, sex, parental atopy history, and 25-(OH) D3 level by multiple regression. Vitamin D levels in BM for exclusively breastfed infants were negatively associated with objSCORAD. Lower vitamin D levels in BM might be a risk factor for infantile AD.

113 Epicutaneous allergen exposure induces pathogenic IL-22-producing T helper cells

Atopic dermatitis (AD) is a common inflammatory skin disease resulting from epidermal barrier dysfunction and an immune response dominated by IL-4-producing Th2 cells and IL-22-producing Th22 cells. Environmental antigens like food allergens are thought to influence the clinical course of AD. We aimed to study the pathogenic phenotype of food allergen-specific T cells activated through the skin or by oral exposure and their potency to transfer skin inflammation. Ovalbumin (OVA) TCR-transgenic mice were sensitized epicutaneously with OVA or were fed OVA. CD4+ T cells from skin or mesenteric lymph nodes were phenotyped for cytokine expression and transferred into naïve BALB/c mice. Recipient mice were challenged with OVA epicutaneously. Skin inflammation was determined histologically. T cells activated through epicutaneous or oral OVA exposure in donor mice both migrate to skin lymph nodes after adoptive transfer and epicutaenous OVA exposure of recipient mice. Importantly, AD-like skin inflammation could only be induced by the transfer of epicutaneously primed OVA T cells. Analysis of the immune phenotype demonstrated an IL-22/IL-17A-dominated immune phenotype of skin-pathogenic T cells. IL-22 seems to be the critical cytokine for the development of AD and is induced in this model by epicutaneous sensitization with OVA.

Современные особенности клинического течения атопического дерматита, осложненного вторичной инфекцией. Выбор тактики терапии

Современные особенности клинического течения атопического дерматита, осложненного вторичной инфекцией. Выбор тактики терапии

The prevalence of atopic dermatitis beyond childhood: A systematic review and meta-analysis of longitudinal studies.

BackgroundThere are sparse and conflicting data regarding the long‐term clinical course of atopic dermatitis (AD). Although often described as a childhood disease, newer population‐based estimates suggest the prevalence of pediatric and adult disease may be similar.MethodsOur objective was to determine whether there is a decline in the prevalence of AD in population‐based cohorts of patients followed longitudinally beyond childhood. We conducted a systematic review and meta‐analysis including studies assessing AD prevalence across 3 or more points in time. The primary outcome was weighted overall risk difference (percentage decrease in AD prevalence).ResultsOf 2080 references reviewed, 7 studies with 13 515 participants were included. Participants were assessed at 3‐6 time points, ranging from age 3 months to 26 years. The percentage decrease in prevalence after age 12 was 1%, which was not significantly different from zero (95% confidence interval −2%‐5%). Similar results were found with other age cut‐offs.ConclusionThe prevalence of AD in longitudinal birth cohort studies is similar in childhood and adolescence/early adulthood.

374 Epicutaneous allergen exposure induces pathogenic IL-22-producing T helper cells

Atopic dermatitis (AD) is a common inflammatory skin disease resulting from epidermal barrier dysfunction and an immune response dominated by IL-4-producing Th2 cells and IL-22-producing Th22 cells. Environmental antigens like food allergens are thought to influence the clinical course of AD. We aimed to study the pathogenic phenotype of food allergen-specific T cells activated through the skin or by oral exposure and their potency to transfer skin inflammation. Ovalbumin (OVA) TCR-transgenic mice were sensitized epicutaneously with OVA or were fed OVA. CD4+ T cells from skin or mesenteric lymph nodes were phenotyped for cytokine expression and transferred into naïve BALB/c mice. Recipient mice were challenged with OVA epicutaneously. Skin inflammation was determined histologically. T cells activated through epicutaneous or oral OVA exposure in donor mice both migrate to skin lymph nodes after adoptive transfer and epicutaenous OVA exposure of recipient mice. Importantly, AD-like skin inflammation could only be induced by the transfer of epicutaneously primed OVA T cells. Analysis of the immune phenotype demonstrated an IL-22/IL-17A-dominated immune phenotype of skin-pathogenic T cells. IL-22 seems to be the critical cytokine for the development of AD and is induced in this model by epicutaneous sensitization with OVA.

The impact of vitamin D supplementation on serum cathelicidin levels and the clinical course of atopic dermatitis in children.

Cathelicidin has been correlated with the pathophysiology of atopic dermatitis (AD). An indirect correlation of vitamin D with the course of the disease has already been reported as it directly affects the levels of cathelicidin. The purpose of the present article is to investigate the impact of vitamin D supplementation on the course of AD. We conducted a prospective observational study. The severity of AD was assessed with the clinical tool SCORAD (SCORing Atopic Dermatitis) which is developed by the European Task Force on AD. Fifty children with AD were enrolled and stratified in two groups based on the severity of SCORAD. Children with severe AD (SCORAD index> 40) received higher doses of vitamin D in order to sufficiently reduce the disease (comparable index SCORAD children with mild atopic dermatitis). While the baseline SCORAD differed statistically significant level between the two groups of children with AD (p <.001) this difference disappeared at 20 (p = .649) days and remained statistically insignificant both at 45 days (p = .610), and at the end of the administration of treatment (p = .474) (Table). This effect was based on a significant downregulation of the severity of symptoms in the group of children that received 2400 IU of vitamin D. The findings of our study suggest that vitamin D may be accurately used in current clinical practice for the management of AD. However, the recommended dose should be titrated taking in mind the severity of the disease.

СТАН КЛІТИННОГО ТА ГУМОРАЛЬНОГО ІМУНІТЕТУ, ЦИТОКІНОВИЙ СТАТУС І МЕДІАТОРИ ЗАПАЛЕННЯ ПРИ АТОПІЧНОМУ ДЕРМАТИТІ В ДІТЕЙ.

У даній статті наведено результати імунологічного обстеження дітей з атопічним дерматитом та практично здорових дітей віком від 1 до 18 років. Виявлено зміни та проведено оцінку показників клітинної і гуморальної ланок імунітету, цитокінового статусу та рівня сироваткових імуноглобулінів, що залежали від ступеня тяжкості клінічного перебігу атопічного дерматиту. Оцінку тяжкості перебігу захворювання проводили напівкількісним методом за індексом SСORAD (Scoring of Atopik Dermatitis). Обґрунтовано доцільність і перспективу застосування імунологічного обстеження у дітей з атопічним дерматитом для оцінки динаміки перебігу захворювання.

Особливості перебігу атопічного дерматиту у дітей за наявності поліморфізму (R501Х) та (2282del4) в гені філагрину

Особливості перебігу атопічного дерматиту у дітей за наявності поліморфізму (R501Х) та (2282del4) в гені філагрину