Abstract
Background: Atopic dermatitis (AD) is a chronic, relapsing, pruritic, inflammatory skin disease with a complex genetic and immunological background. It is a superficial inflammation of the skin that can seriously affect health quality of infants, children and adults. The frequency of this disease is increasing gradually the last decades, especially in older people. The prevalence of AD is 10-20% in children and 1-3% in adults and in developed countries has increased twofold to threefold over the past 3 decades, and there is evidence to suggest that the prevalence is continuing to increase [2,3]. The pathogenesis of the disease remains to be elucidated and includes a disturbed skin barrier function, frequent allergic responses against allergens, defects in the antimicrobial immune defence, and a genetic predisposition. During the past decade extraordinary progress has been made and recent studies provide insights into the underlying immunologic mechanisms, suggesting that chemokines and ...
Background: Atopic dermatitis (AD) is a chronic, relapsing, pruritic, inflammatory skin disease with a complex genetic and immunological background. It is a superficial inflammation of the skin that can seriously affect health quality of infants, children and adults. The frequency of this disease is increasing gradually the last decades, especially in older people. The prevalence of AD is 10-20% in children and 1-3% in adults and in developed countries has increased twofold to threefold over the past 3 decades, and there is evidence to suggest that the prevalence is continuing to increase [2,3]. The pathogenesis of the disease remains to be elucidated and includes a disturbed skin barrier function, frequent allergic responses against allergens, defects in the antimicrobial immune defence, and a genetic predisposition. During the past decade extraordinary progress has been made and recent studies provide insights into the underlying immunologic mechanisms, suggesting that chemokines and cytokines in peripheral blood and in the skin orchestrate atopic skin inflammation. Objectives: In this study we investigated serum levels of several cytokines of both Th1 and Th2 type (IL-4, IL-6, IL-2, IL-10, IFN-γ and tumour necrosis factor, TNF) in patients with AD in order to assess the possible relationship between such cytokines and the disease severity of AD (SCORAD index) by using flow cytometry on unseparated whole blood, and to clarify the discrepancy between cytokine production results from previous studies. Methods: The patient group included 43 patients (25 males, 18 females) with atopic dermatitis, who visited our Hospital between January 2007 and December 2007and was divided in 3 subgroups. In group 1, adults with acute AD (15 male and 6 female) the mean age was 35.66± 5.73 years. In group 2: 10 patients 0-2 years of old in acute phase (6 men and 4 women) and in group 3: 12 patients more than 3 years of old in chronic phase of AD (8 men 4 women). The control group 4 included 10 non-atopic healthy adults (6 men and 4 female) was aged match with group 1 (mean 31±1.68 years). Results: The mean severity of group 1, which was our target group, estimated according the SCORAD index was 47.3±3.59 (min18-max 68.5). The values of SCORAD index in group 2 and group 3 were 31.15±2.66 and 19.70±1.85 respectively. The level of total serum IgE in group 1 patients, was ranged between 45.72 and 1001 IU/mL (mean=254.88±69.62), while in the healthy non-atopic control group was between 62.10-96.20 IU/mL (mean=80.39±3.29). There was a significant correlation between the severity score of atopic dermatitis and the level of total serum IgE (n=21, r =0.59, p<0.005). The level of eosinophil were significantly increased in group 1 (mean 0.51*103/uL) compared with controls (mean 0.21*103/uL). The flow cytometric detection of cytokines showed that the production of IL-4, IL-6 IL-10 and IFN-γ were significantly decreased (IL-4 p=0.024, IL-10 p=0.012, IL-6 p=0.002, IFN-γ p=0.0001) in patients with acute atopic dermatitis compared with healthy controls. There was no statistical difference in the levels of IL-2 and TNF. From statistical analysis there was no correlation between either IFN-γ or IL-4 and the severity of the disease. On the contrary, we found that the co-efficient variation of SCORAD index depends on TNF at a higher percentage (29,92%) than IgE (21.25%) and eosinophil (22%). Another important result was that there was a positive relation between TNF and the SCORAD index and also the level of IgE. Conclusions: These data strongly suggest that serum IgE levels seem to correlate with the degree of eczema. Also our results provide evidence that serum cytokines are downregulated and that TNF has a potential role in the pathogenesis of AD, with regard to skin inflammation, as assessed by the positive correlation with AD severity.
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