The Complexities of Atopic Dermatitis Severity

A recent study conducted by the Atopic Dermatitis Research Network aimed to identify the historical, clinical, and biomarker determinants associated with the severity of atopic dermatitis.

This investigation harnessed the extensive resources of a national registry consisting of patients with atopic dermatitis, spanning a wide age range from infancy (age 0.73 years) to adulthood (age 80 years). These patients underwent comprehensive clinical assessments at 9 academic centers across the United States. Data collected included personal and family medical histories, clinical examinations, skin swabs for culture, and serum biomarkers, with the goal of understanding the factors contributing to variations in atopic dermatitis severity.

The study involved 2862 patients with atopic dermatitis, categorized into 3 severity levels: mild (11.6%), moderate (58.0%), and severe (30.4%). Upon conducting a rigorous analysis, which was adjusted for gender, race, and age, several intriguing associations between disease severity and various factors were uncovered.

The results indicated a strong correlation between severity and personal or family histories of allergic disorders, alopecia, exposure to passive smoke, ocular herpes infections, and a history of arrhythmia. Furthermore, distinct clinical characteristics, such as specific skin infections (impetigo, human papillomavirus, and molluscum contagiosum virus), Staphylococcus aureus colonization, excoriations, hyperlinear palms, ichthyosis, blepharitis, conjunctivitis, ectropion, and wheezing, were notably more prevalent as the severity of atopic dermatitis increased.

The study also revealed that serum biomarkers played a pivotal role in determining disease severity. Elevated serum IgE levels; allergen and food sensitivities, particularly in patients aged 6 years or younger (assessed using Phadiatop); and eosinophilia were robustly associated with more severe presentations of the condition.

“Data from our prospective registry significantly advance our understanding of [atopic dermatitis] phenotypes and endotypes, which is critical to achieve optimal management,” concluded the study authors.

Reference
Simpson EL, De Benedetto A, Boguniewicz M, et al. Phenotypic and endotypic determinants of atopic dermatitis severity from the Atopic Dermatitis Research Network (ADRN) registry.  J Allergy Clin Immunol Pract. 2023;11(8):2504-2515. doi:10.1016/j.jaip.2023.04.052