The Journal of Allergy and Clinical Immunology
Volume 121, Issue 3 , Pages 725-730.e2, March 2008

Intrinsically defective skin barrier function in children with atopic dermatitis correlates with disease severity

  • Jayanta Gupta, MD

      Affiliations

    • Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • Institute of Personalized and Predictive Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Emilie Grube, BA

      Affiliations

    • Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Mark B. Ericksen, BS

      Affiliations

    • Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • Institute of Personalized and Predictive Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Michelle D. Stevenson, MD, MS

      Affiliations

    • Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Anne W. Lucky, MD

      Affiliations

    • Division of Pediatric Dermatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Anita P. Sheth, MD

      Affiliations

    • Division of Pediatric Dermatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Amal H. Assa'ad, MD

      Affiliations

    • Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • ,
  • Gurjit K. Khurana Hershey, MD, PhD

      Affiliations

    • Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • Institute of Personalized and Predictive Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
    • Corresponding Author InformationReprint requests: Gurjit K. Khurana Hershey, MD, PhD, Institute of Personalized and Predictive Medicine and Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7028, Cincinnati, OH 45229.

Received 1 October 2007; received in revised form 14 December 2007; accepted 17 December 2007. published online 13 February 2008.

Background

Recent genetic evidence supports that an underlying defect in skin barrier function contributes to the pathogenesis of atopic dermatitis (AD). The integrity of the skin barrier can be assessed objectively by measuring transepidermal water loss (TEWL). Previous investigations of TEWL as a biomarker of skin barrier function have been limited by small sample size, and studies including African American subjects are lacking.

Objective

We sought to determine whether children with AD have inherently altered skin barrier function by comparing TEWL as a measure of skin barrier function in African American and white children with AD with that in control subjects without AD.

Methods

TEWL was measured on nonlesional normal-appearing skin at 4 sites (the volar forearm, dorsal arm, lower leg, and cheek) in (1) children with AD (cases), (2) children with asthma or allergic rhinitis but without AD (allergic control subjects), and (3) nonatopic control subjects. AD severity was assessed by using the objective SCORAD index.

Results

TEWL was increased in children with AD compared with that seen in both control groups at most of the anatomic sites tested (P < .05). TEWL also correlated with objective SCORAD score. The presence of allergic sensitization or other allergic conditions did not affect TEWL among children with AD. TEWL was higher in white than in African American children.

Conclusion

Skin barrier function as assessed by TEWL is intrinsically compromised in children with AD but not in children with other allergic conditions. The magnitude of skin barrier dysfunction correlates with AD disease severity.

Key words: Atopic dermatitis, transepidermal water loss, objective SCORAD, African American, white

Abbreviations used: AD, Atopic dermatitis, TEWL, Transepidermal water loss

 

 Supported by National Institutes of Health grant U19A170235-01 (GKKH) and the University of Cincinnati, Molecular Epidemiology in Children's Environmental Health–Institutional NIEHS T32 ES10957 (MDS) and Cincinnati Children's Hospital Medical Center–Institutional NICHD T32 HD43005 (MDS).

 Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

PII: S0091-6749(07)03611-1

doi:10.1016/j.jaci.2007.12.1161

The Journal of Allergy and Clinical Immunology
Volume 121, Issue 3 , Pages 725-730.e2, March 2008