Severity Scoring Of Atopic Dermatitis Research Articles

146 A Bayesian machine learning model to identify patient-specific dynamic responses to eczema treatments

Successful control of atopic dermatitis (AD) symptoms is challenging due to considerable variation in responses to treatments between patients. Personalised treatment strategies may be more beneficial to individual patients rather than a “one-size-fits-all” approach to therapy. Choice of appropriate treatments for each patient is facilitated by better prognoses of AD severity dynamics. However, it is difficult to reliably identify and predict treatment effects at an individual level, due to the fluctuating dynamics of AD symptoms. We applied a machine learning approach to analyse and learn dynamic patterns of AD severity scores for each patient and developed a Bayesian machine learning model for personalised prediction of daily AD severity scores. While most machine learning models lack interpretability and can be unsuitable for clinical use, our model adopted the structure of a previously published mechanistic model of AD pathogenesis, making it biologically interpretable. The model was developed using the already published longitudinal data of the daily recordings of AD severity scores and treatment used by 59 AD children over 6 months, and externally validated using a similar dataset of 334 AD children followed for 16 weeks. We validated and confirmed the general applicability of the model. The model predictions of the daily evolution AD severity score were 60% more accurate than chance-level forecasts. The model was able to capture diverse patterns of severity trajectories while dealing with partially missing data. We also derived patient-dependent parameters that describe the short-term persistence of AD symptoms and dose-independent responsiveness to topical steroids, calcineurin inhibitors and step-up treatments. The method proposed in this study is applicable to design complex yet interpretable machine learning models for clinical use. By predicting whether a chosen treatment is consistently effective and whether the disease is adequately controlled, for each patient, the method could help suggest personalised treatment strategies.

Prebiotics and probiotics in atopic dermatitis (Review)

Recent years have brought additional data on the benefits of prebiotics and probiotics treatment in patients with atopic dermatitis. This review includes all the articles published in PubMed, Scopus, Embase and Cochrane databases until 05.06.2018. The terms used for the search were 'prebiotic', 'probiotic', 'atopic dermatitis', 'Severity Scoring of Atopic Dermatitis', and 'SCORAD'. There was an increase of the intestinal permeability reported in patients with atopic dermatitis and a reduction of the cutaneous microbiome diversity. Probiotics modulate the general microbiome and immune status by improving the intestinal barrier; these effects can be responsible for reducing allergic phenomenon and atopic dermatitis severity. We have structured the results by age groups as infants, 1-18 years, adults, and also pregnancy and lactation. Literature does not offer yet answers on the issues such as the optimal dosing, duration needed to see beneficial effects, the optimal time to start the treatment; the personalized use of probiotics according to colonic dysbiosis may be associated with better results. However, most randomized controlled trials and meta-analyzes support the administration of probiotics for at least 8 weeks in order to obtain beneficial effects in improving severity scoring of atopic dermatitis.

Efficiency and tolerability of drug AEvit in complex treatment of patients with atopic dermatitis

Objective — to evaluate the effectiveness and tolerability of drug AEvit in the complex treatment of patients with atopic dermatitis (AD).Materials and methods. We observed 100 patients with AD, who were randomized into the main (50 patients) and control (50 patients) groups. Demographic and anamnestic data were collected from all patients, clinical signs of AD on the SCORAD (Severity scoring of atopic dermatitis: Consensus Report of the European Task Force on Аtopic Dermatitis) scale were evaluated, general clinical biochemical studies were performed. Inclusion criteria were: male and female gender, age from 18 to 70 years, diagnosis of AD in the stage of exacerbation established on the basis of the criteria of Hanifin and Rajka1; moderate or severe degree of the disease (30—70 points on the SCORAD scale); affected area < 30 % of the body surface. Patients underwent standard therapy. Patients of the main group additionally took AEvit, 1 capsule per day after meals for 30 days. Statistical processing of the obtained results was carried out with the use of methods of biometric analysis implemented in the packages of licensed programs Excel 2003 and Statistica 6.1 (StatSoft Inc., serial number AGAR909E415822FA).Results and discussion. Analysis of the anamnestic data allowed establishing the duration of the disease: up to 1 year — in 27 patients, 1—5 years — in 45 patients, 5—10 years — in 21 patients, more than 10 years — in 7 patients. There were 35 (35 %) men and 65 (65 %) women among the examined patients with AD. The duration of the disease according to the anamnestic history was 52.8 years in the main group, and 4.18 — in the control group. After the course of treatment, 28 (56 %) patients of the main group and 19 (38 %) patients of the control group achieved complete clinical remission of the disease. In all other cases, a significant reduction in the SCORAD index was achieved.Conclusions. There was a statistically significant decrease in the severity of the symptoms of the disease in both groups, but it was much more pronounced in the group of patients who used AEvit in the complex treatment.

Dietary habits in adult Japanese patients with atopic dermatitis.

Dietary habits can modulate the pathogenesis of atopic dermatitis. We evaluated these habits in adult Japanese patients with atopic dermatitis using a validated, brief-type self-administered diet history questionnaire and compared the results to those of age- and sex-matched healthy controls. Patients with atopic dermatitis showed higher intakes of carbohydrate and potatoes and lower intakes of alcohol, niacin, meat and oils/fats compared with those of the healthy controls. The results of logistic regression analysis showed that the intake of alcohol was negatively associated with atopic dermatitis (odds ratio, 0.905; 95% confidence interval, 0.832-0.983; P=0.0181). The intakes of vitamin B6 and fruit were positively correlated with the severity scoring of atopic dermatitis. Multiple regression analysis revealed that vitamin B6 intake was a predictor of the severity scoring of atopic dermatitis (β=26.98508709, t=2.3995292, P=0.01933781). The intakes of vegetable fat, n-6 polyunsaturated fatty acid, and confections were lower in the severe atopic dermatitis group (severity scoring of atopic dermatitis, ≥33) than those in the mild group. Atopic dermatitis is negatively associated with alcohol intake, and intake of vitamin B6 is a predictor of severity scoring of atopic dermatitis. The intake of n-6 polyunsaturated fatty acid is lower in the severe atopic dermatitis group than that in the mild group. Further study is warranted on the relationships of these results with abnormal immune responses, impaired skin barrier or pruritus in atopic dermatitis.

Therapeutic potential of topically administered γ-AlOOH on 2,4-dinitrochlorobenzene-induced atopic dermatitis-like lesions in Balb/c mice.

Boehmite (γ-AlOOH) has a wide range of applications in a variety of industrial and biological fields. However, little is known about its potential roles in skin diseases. The current study investigated its effect on atopic dermatitis (AD). Following characterization, cytotoxicity, pro-inflammatory response and oxidative stress associated with boehmite were assessed, using TNF-α-induced keratinocytes and mast cells. In addition, therapeutic effects of boehmite, topically administered to Balb/c mice induced by 2,4-dinitrochlorobenzene (DNCB), were evaluated. Expression of cytokines (TLSP, IL-25 and IL-33) and the generation of ROS from keratinocytes induced by TNF-α were significantly inhibited by boehmite without affecting cell viability. MAPKs (ERK, JNK and p38) required for cytokine expression were suppressed by boehmite treatment. Up-regulation of cytokines (TSLP, IL-4, IL-5, IL-13, RANTES) in human mast cells treated with phorbol 12-myristate 13-acetate and calcium ionophore was also suppressed by boehmite. Boehmite improved the AD severity score, epidermal hyperplasia and transepidermal water loss in DNCB-induced AD-like lesions. Moreover, Th2-mediated cytokine expression, mast cell hyperplasia and destruction of the skin barrier were improved by boehmite treatment. Overall, we demonstrated that boehmite may potentially protect against AD.

Classification of established atopic dermatitis in children with the in vivo imaging methods.

Atopic dermatitis (AD) is a cutaneous disease resulting from a defective barrier and dysregulated immune response. The severity scoring of atopic dermatitis (SCORAD) is used to classify AD. Noninvasive imaging approaches supplementary to SCORAD were investigated. Cr:forsterite laser-based microscopy was employed to analyze endogenous third-harmonic generation (THG) and second-harmonic generation (SHG) signals from skin. Imaging parameters were compared between different AD severities. Three-dimensional reconstruction of imaged skin layers was performed. Finally, statistic models from quantitative imaging parameters were developed for predicting disease severity. Our data demonstrate that THG signal intensity of lesional skin in AD were significantly increased and was positively correlated with AD severity. Characteristic gray level co-occurrence matrix (GLCM) values were observed in more severe AD. In the 3D reconstruction video, individual dermal papilla and obvious fibrosis in the upper papillary dermis were easily identified. Our estimation models could predict the disease severity of AD patients with an accuracy of nearly 85%. The THG signal intensity and characteristic GLCM patterns are associated with AD severity and can serve as quantitative predictive parameters. Our imaging approach can be used to identify the histopathological changes of AD objectively, and to complement the SCORAD index, thus improving the accuracy of classifying AD severity.

The Evaluation of Mean Platelet Volume in Infants with Atopic Dermatitis

Aim: Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that commonly seen in the infancy period. Platelets are involved in the inflammation process. Mean platelet volume (MPV) is one of the inflammatory indicators that have been used in recent years. The aim of this study is to evaluate the relationship between the MPV and AD in infants. Material and Methods: Sixty-four infants with AD aged between 2-12 months and, 50 healthy infants as control with same age and sex were included to study. MPV values of the subjects were compared between the groups. The AD group was also divided into 3 subgroups according to the Severity Scoring of Atopic Dermatitis (SCORAD) index. Correlation analyses of MPV were performed to each group. Results: MPV levels were significantly lower in infants with AD when compared to healthy control (9.64±0.65 and 10.20±0.91, respectively, p

Atopic Dermatitis in Adults and Irritable Bowel Syndrome: A Cross-sectional Study.

Background:Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people in the world. Atopic dermatitis (AD) is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It was first described in 1933 but exists since antiquity.Aim and Objectives:To determine the relationship between AD and IBS.Materials and Methods:A total of 109 patients with AD and 100 healthy controls were included in the study. They were defined for diagnosis of IBS according to ROME-III diagnostic criteria. Supporting findings, Bristol stool scale, frequency of defecation and history of AD and IBS were also evaluated. AD severity was assessed using Severity Scoring of Atopic Dermatitis index.Results:A total of 62 patients (56.9%) in the AD group and 28 patients (28%) in the control group were diagnosed with IBS (P<0.001). Supportive findings excluding abnormal stool frequency and passage of mucus were more frequent in AD patients. There was no significant relationship between disease severity according to SCORAD index and variables in AD patients.Conclusions:This is a rather uncultivated area in the field of AD. We observed that IBS was more common in AD group. Also, supporting findings like abnormal stool form, abdominal distension, feeling of incomplete evacuation, and straining were found more frequently in AD patients. These results may indicate the association between AD and IBS. In our opinion, patients with atopic dermatitis should be questioned in terms of IBS.

Correlation between Serum Interleukin-31 Level and the Severity of Atopic Dermatitis in Children

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by intense itch, typical localization and a specific image of skin lesions. Pathogenesis of pruritus in AD is not fully understood, but recent studies emphasize the role of interleukin-31 (IL-31). This relatively recently described cytokine is considered to be a potential mediator inducing pruritus in AD. Aim of the Work: was to assess the correlation of serum IL-31 level and the disease severity in children with AD. Patients and Methods: a case control study. Sera were obtained from 50 AD children and 30 healthy volunteers. IL-31 levels were measured using ELISA with standard kits from EIAab R&D Systems. Serum IL-31 levels were correlated with AD disease activity. Disease severity in children with AD was assessed using the SCORAD (Severity scoringof atopic dermatitis) index. Results: Serum IL-31 level was significantly higher in AD children (Mean ± SD 99.73 ± 75.93) than in healthy children (Mean ± SD 54.01 ± 57.36), (p-value = 0.019). Serum IL-31 levels correlated positively with the calculated severity score (SCORAD index), (rs = 0.480, p- value <0.001) Conclusion: The results of this study confirm the importance of IL-31 in AD pathophysiology. Serum IL-31 level is an objective reliable marker of AD severity in children. It may represent a novel target for antipruritic drug development.

Correlation between Serum Interleukin-31 Level and the Severity of Atopic Dermatitis in Children

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by intense itch, typical localization and a specific image of skin lesions. Pathogenesis of pruritus in AD is not fully understood, but recent studies emphasize the role of interleukin-31 (IL-31). This relatively recently described cytokine is considered to be a potential mediator inducing pruritus in AD. Aim of the Work: was to assess the correlation of serum IL-31 level and the disease severity in children with AD. Patients and Methods: a case control study. Sera were obtained from 50 AD children and 30 healthy volunteers. IL-31 levels were measured using ELISA with standard kits from EIAab R&D Systems. Serum IL-31 levels were correlated with AD disease activity. Disease severity in children with AD was assessed using the SCORAD (Severity scoringof atopic dermatitis) index. Results: Serum IL-31 level was significantly higher in AD children (Mean ± SD 99.73 ± 75.93) than in healthy children (Mean ± SD 54.01 ± 57.36), (p-value = 0.019). Serum IL-31 levels correlated positively with the calculated severity score (SCORAD index), (rs = 0.480, p- value <0.001) Conclusion: The results of this study confirm the importance of IL-31 in AD pathophysiology. Serum IL-31 level is an objective reliable marker of AD severity in children. It may represent a novel target for antipruritic drug development.

Impact of atopic dermatitis on the quality of life of Nigerian children: A hospital-based cross-sectional study

Background. Atopic dermatitis (AD) is the most common inflammatory skin disease in childhood. A skin disorder with a relapsing course, AD exerts a significant disease burden on affected children. However, there is a dearth of knowledge about the impact of AD on the quality of life (QOL) of affected children in Nigeria. Objectives. To examine the impact of AD on QOL in children of various age groups, and to identify the relationship between patient variables (age, gender, socioeconomic status), disease severity and QOL in AD. Method. This was a cross-sectional descriptive study of children with AD attending the dermatology clinic of Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. AD cases were recruited from new paediatric patients ≤16 years who attended the clinic over a 6-month period. English and Yoruba versions of the Infants’ Dermatitis Quality of Life Index (IDQOL) and the Children’s Dermatology Life Quality Index (CDLQI) were used to determine the QOL of the subjects. AD severity was evaluated using the Objective SCORing of Atopic Dermatitis (obj-SCORAD) index. Results. Forty-seven subjects with AD were identified. Their ages ranged from newborn to 16 years. The median(interquartile range (IQR)) IDQOL score was 6.0 (3.0 - 15.5; n =25), and the median (IQR) CDLQI score was 9.5 (7.75 - 17.75; n =22). The mean (standard deviation) obj-SCORAD score was 34.4 (17.2). The question on itching was the highest-scoring question in both QOL questionnaires. There was no significant difference in QOL across age, gender and socioeconomic status groups. However, greater QOL scores were significantly correlated with higher AD severity scores. Conclusion. The study confirms that AD impairs the QOL of affected children in all age groups. QOL assessments are relevant tools which provide a patient’s perspective, thus improving the understanding of the impact of AD on afflicted individuals.

Probiotics for treating eczema.

Probiotics for treating eczema.

Effect of synbiotic supplementation on children with atopic dermatitis: an observational prospective study

The objective of this observational single-cohort prospective study was to assess the effect of synbiotic supplementation for 8 weeks in children with atopic dermatitis (AD). The synbiotic product contained Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin. Patients were examined at baseline and at 8 weeks. Effectiveness of treatment was assessed with the Scoring Atopic Dermatitis (SCORAD) index. A total of 320 children (mean age 5.1 years, range 0–12 years) were included. The mean (SD) SCORAD index decreased from 45.5 (15.5) at baseline to 19.4 (14.6) at the end of treatment (P < 0.001), VAS score for pruritus decreased from 5.7 (2.2) to 2.3 (2.2) (P < 0.001), and VAS score for sleep decreased from 3.1 (2.5) to 1.1 (1.8) (P < 0.001). Percentage of children with moderate-severe disease decreased from 92.4% at baseline to 28.1% at week 8. In the multiple linear regression analysis, higher baseline SCORAD index (OR 0.51; 95% CI 0.41–0.61) and higher adherence (OR 7.29; 95% CI 1.85–12.73) were significantly associated with greater decrease in SCORAD index.Conclusion: Supplementation with the multistrain synbiotic product may improve AD in children.What is known: • Pediatric atopic dermatitis (AD) is a common, troublesome condition with limited treatment options, which has been shown to be associated with dysbiosis in the intestinal microflora. • Results of controlled clinical trials (RCTs) on the effect of probiotics in children with AD have been disparate, although overall, the data favor probiotics over placebo, with multistrain supplements associated with better improvements in AD.What is new: • The results of this observational, prospective, open-label, single-cohort study on 320 children with AD younger than 12 years old suggest that supplementation with multistrain synbiotics (Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin) helps to improve AD symptoms in children. • More than 80% of children experienced improvement in AD symptoms, as measured by Severity Scoring of Atopic Dermatitis (SCORAD) index and assessed by parents and physicians. The main predictive factors for improvement was adherence to synbiotic treatment and high baseline SCORE index; the change in SCORAD did not depend on age, gender, presence of concomitant treatment, duration, and type of AD (persistent vs with flares), other concomitant allergies or history of parental allergy.

Relationship and probabilistic stratification of Eczema Area and Severity Index and objective Scoring Atopic Dermatitis severity scores for atopic dermatitis

Relationship and probabilistic stratification of Eczema Area and Severity Index and objective Scoring Atopic Dermatitis severity scores for atopic dermatitis

An Investigator Blinded, Clinical Trial Assessing the Efficacy of Superfine Merino Wool Base Layer Garments (SMWBG) in Children with Atopic Dermatitis (AD) Measuring SCORAD1, EASI2, POEM3 and DSA4 Scores

Atopic Dermatitis (AD) is a chronic inflammatory skin disease, which occurs most often in children compared with the adult AD population [5]. Wool is commonly considered an allergen and trigger for exacerbation of AD. However, Super Fine Merino Wool (SMW) has not been extensively studied and may show some effect in improving AD symptoms such as itch, erythema and induration. To explore this hypothesis, we performed an investigator blinded, repeated measures, self-controlled experimental design study with Super Fine Merino Base Layer Garments (SMWBG). SMWBG were worn by 29 patients with AD between the ages of 6 to 25 years over a 15 week period. We examined the tolerability and potential therapeutic effect of SMWBG (garments worn directly against the skin) in children and young adults with atopic dermatitis (AD). Response was assessed using validated scoring scales: Severity Scoring of Atopic Dermatitis (SCORAD1), Eczema Area Severty Index (EASI2), Patient-Orientated Eczema Measures (POEM3) and a non-validated Dermatitis Severity Assessment (DSA4). Wilcoxon signed-rank tests were conducted to measure the difference between garment intervention phases. Statistically significant results were observed between the pre-garment intervention phase and the with-garment interventionphases for many of the scores. Results found that SMWBG were well-tolerated in children and young adults as an adjunctive therapy for the treatment of AD. This study was conducted in Brisbane, Australia between July 2014 and October 2015 and is Human Research Ethics Committee (HREC) approved.

Skin Ceramide Profile in Children With Atopic Dermatitis.

Atopic dermatitis (AD) is a common disease, which involves a disruption of the skin barrier function. Skin ceramide (CER) composition, which plays crucial roles in maintaining the barrier function of the stratum corneum, is changed in patients with AD. The aim of this study was to identify and quantify skin CER subclasses in association with disease severity in pediatric patients with AD. Two hundred thirteen patients were entered into the observational study. We compared their CER profiles using normal-phase high-performance liquid chromatography coupled with dynamic multiple reaction monitoring mass spectrometry. In total, 12 subclasses of CERs were identified. We found that 2 subclasses, that is, CER[AS] and CER[NS], were elevated (P = 0.007 and 0.012, respectively) and correlated with Severity Scoring of Atopic Dermatitis (P = 0.004 and 0.004, respectively). Skin CER abundances are changed in children with AD compared with control subjects.

Assessment of IL-31 levels and disease severity in children with atopic dermatitis

Introduction and objectivesAtopic dermatitis is a chronic, relapsing, highly pruritic, inflammatory skin disease characterized by typical localization with increasing prevalence of 10–20% in children. Pruritus is one of the major diagnostic criteria of atopic dermatitis and also the main complaint altering quality-of-life of affected patients, inducing and aggravating inflammation. Although pruritus is the absolute symptom of AD, the etiology has not been fully explained yet and current antihistamine therapies are ineffective.The aim of the study was to assess the correlation between IL-31 level and disease severity in patients with atopic dermatitis through Severity SCORing of Atopic Dermatitis (SCORAD) index and the degree of itching assessed subjectively. Material and methodsOne hundred thirty-five children were enrolled in the study in total, 70 children with diagnosis of atopic dermatitis and 65 healthy children in control group. Data on demographic features (age, gender, family history of atopy) and laboratory values of serum eosinophil, total IgE, IgM, IgA, IgG levels and skin prick test results were collected through patient files. The disease severity was assessed by SCORAD index. IL-31 levels were measured with human IL-31 ELISA kit. ResultsThe statistical analysis showed that IL-31 level was significantly higher in AD patients than in the control group (AD vs CG, p 0.0001). There was no significant difference in IL-31 levels between the three subgroups divided according to the SCORAD severity score (p:0.27). ConclusionIL-31 levels were significantly higher in AD patients compared to control group but irrelevant to the disease severity.

Effect of ozone on Staphylococcus aureus colonization in patients with atopic dermatitis

To verify the effect of ozone on Staphylococcus aureus (S. aureus) colonization in patients with atopic dermatitis (AD) and its correlation with the patient's status. Methods: A total of 12 patients with moderate or severe AD, aged from 6 to 65 years, were recruited from outpatient of the Third Xiangya Hospital. The treatment sides were showered with ozonated water and smeared with ozonated oil for 7 days (twice a day), while the control sides were washed with warm running water and smeared with base oil. At different time points, the severity scoring of atopic dermatitis (SCORAD) scores, sleep and pruritus scores were assessed and compared between the two sides. Meanwhile, plate cultivation was used to quantitatively detect the changes of S. aureus colonization in skin lesions. Results: After 7 days treatment, erythema and pimples were decreased in the treatment sides. The clear skin texture, smooth skin, improved skin lesions were also observed by dermoscopic examination. The results of reflectance confocal microscopy (RCM) demonstrated that the parakeratosis was improved, the structures were clearer, and the inflammatory cells infiltration was reduced after ozone treatment for 7 days. After ozone treatment for 3 and 7 days, the S. aureus colonization in the treatment sides decreased by (75.55±21.81)% and (97.24±2.64)% respectively. Compared to that of control sides, the percentage of S. aureus colony after ozone treatment for 7 days decreased significantly (P<0.01). After ozone treatment for 7 days, the SCORAD scores, sleep and pruritus scores were significantly decreased (all P<0.01). There was a linear correlation between the decreasing percentage of S. aureus colony and the declining percentage of SCORAD scores in AD patients. Conclusion: Topical ozone therapy can effectively reduce S. aureus colony in skin lesions and alleviate the severity of AD patients with moderate to severe degree.

Disagreement Between Skin Prick Tests and Specific IgE in Early Childhood

A Chauveau, ML Dalphin, V Kaulek. Int Arch Allergy Immunol. 2016;170(2):69–74 To evaluate for agreement between the results of skin prick tests (SPTs) and serum-specific immunoglobulin E (SSIgE) testing for sensitivity to environmental aeroallergens and food allergens in children. The authors of this study also assessed the associations between SPTs with positive results and the presence of atopic dermatitis in children from ages 1 to 6 years. Test results were available for 204 children from rural areas in France, who were recruited through the Protection against Allergy: Study in Rural Environments (PASTURE) project, which included a cohort of European children managed from birth to 10 years of age to determine the effect of farm exposure on the occurrence of allergies. SPTs, atopic dermatitis evaluations using Scoring Atopic Dermatitis Severity Scores, and SSIgE levels were completed at the …

Altered lipid properties of the stratum corneum in Canine Atopic Dermatitis

Skin barrier disruption plays a role in the pathogenesis of atopic dermatitis (AD) in humans. However, little is known about skin barrier (dys-) function in Canine Atopic Dermatitis. The properties of lipids located in the outermost layer of the skin, the stratum corneum (SC) are considered to be important for the barrier. In the present study the lipid composition and lipid organization of the SC of AD dogs and control dogs were examined. The lipid composition of lesional AD skin as compared to control skin, showed a reduced free fatty acid level and a decreased ratio of ceramide[NS] C44/C34, in which C44 and C34 are the total numbers of carbon atoms of the sphingosine (S) and non-hydroxy (N) acyl chains. As a consequence of the observed changes in lipid composition in AD lesional skin the lamellar organization of lipids altered and a shift from orthorhombic to hexagonal lipid packing was monitored. Simultaneously an increased conformational disordering occurred. These changes are expected to compromise the integrity of the skin barrier. The C44/C34 chain length ratio of ceramide[NS] also showed a decreasing nonlinear relationship with the AD severity score (CADESI). Taken together, canine atopic skin showed alterations in SC lipid properties, similar to the changes observed in atopic dermatitis in humans, that correlated with a disruption of the skin barrier. Hence lipids play an important role in the pathogenesis of Canine Atopic Dermatitis.