Emerging Biomarkers for Diagnosing and Monitoring Atopic Dermatitis

Hudson Everett^*
*Correspondence: Hudson Everett, Department of Pediatrics, Khon Kaen University, Khon Kaen 40002, Thailand, Email:

Keywords

Atopic dermatitis • Atopic dermatitis • Skin disease • Biomarkers

Introduction

Pathophysiology of atopic dermatitis

To understand the significance of biomarkers in AD, it is essential to grasp the underlying pathophysiology of the disease. AD is a multifactorial condition influenced by genetic, environmental and immunological factors. The skin barrier dysfunction, immune dysregulation and microbial imbalance are central to its pathogenesis.

Skin barrier dysfunction: Mutations in the Filaggrin (FLG) gene, which encodes a crucial protein for skin barrier integrity, are strongly associated with AD. Impaired barrier function leads to increased transepidermal water loss and enhanced penetration of allergens and microbes.

Immune dysregulation: AD is characterized by a Th2-dominated immune response, with elevated levels of cytokines such as IL-4, IL-13 and IL-31. These cytokines contribute to inflammation, itching and further barrier disruption [1,2].

Microbial imbalance: The skin microbiome in AD patients shows a higher abundance of Staphylococcus aureus, which exacerbates inflammation and skin damage. Understanding these pathogenic mechanisms is crucial for identifying relevant biomarkers.

Literature Review

Emerging biomarkers in atopic dermatitis

Biomarkers in AD can be broadly categorized into genetic, proteomic and metabolomic markers. These biomarkers offer insights into disease activity, severity and therapeutic response.

Genetic biomarkers: Genetic predisposition plays a significant role in AD. Polymorphisms in genes such as FLG, IL4RA and TSLP have been linked to increased susceptibility to AD. Identifying these genetic variants can aid in early diagnosis and risk stratification [3].

Proteomic biomarkers: Proteomic analysis has revealed several proteins that are differentially expressed in AD patients. Key biomarkers include:

Metabolomic biomarkers: Metabolomic profiling has identified specific metabolites associated with AD. For instance, alterations in lipid metabolism, such as reduced levels of ceramides, are characteristic of AD and contribute to barrier dysfunction.

The integration of biomarkers into clinical practice has the potential to enhance the diagnosis, monitoring and treatment of AD.

Diagnosis: Biomarkers can aid in the early diagnosis of AD, particularly in atypical cases where clinical features are ambiguous. Genetic testing for FLG mutations and measurement of serum TARC levels can improve diagnostic accuracy [4].

Disease monitoring: Biomarkers provide objective measures of disease activity and severity. Regular monitoring of TARC, ECP and IL-31 levels can help clinicians assess treatment efficacy and make informed decisions about therapy adjustments.

Personalized medicine: Biomarkers enable a personalized approach to AD management. By identifying specific immune profiles and genetic predispositions, clinicians can tailor treatments to individual patients, optimizing therapeutic outcomes and minimizing adverse effects.

While the identification of biomarkers for AD is promising, several challenges remain. Standardization of biomarker assays, validation in large cohorts and cost-effectiveness are critical for their routine clinical use. Additionally, the complex interplay between genetic, environmental and immunological factors in AD necessitates a multifaceted approach to biomarker discovery. Emerging technologies such as single-cell RNA sequencing, machine learning and systems biology are expected to drive further advancements in biomarker research. These approaches can uncover novel biomarkers and provide deeper insights into the pathogenesis of AD [5,6].

Discussion

Atopic Dermatitis (AD) is a chronic inflammatory skin condition characterized by itching, redness and eczema. Despite its prevalence, diagnosing and monitoring AD can be challenging due to its heterogeneous nature and overlapping symptoms with other skin disorders. Emerging biomarkers offer promising tools for improving the accuracy and efficiency of AD diagnosis and management. Advanced proteomic and metabolomic analyses have identified numerous potential biomarkers in AD. For example, Thymus and Activation-Regulated Chemokine (TARC/CCL17) and Macrophage-Derived Chemokine (MDC/CCL22) are elevated in AD and correlate with disease activity. Metabolomic profiling has revealed alterations in lipid metabolism, which may reflect skin barrier dysfunction and inflammation.

Conclusion

The emergence of biomarkers in atopic dermatitis marks a significant advancement in the field of dermatology. Genetic, proteomic and metabolomic biomarkers offer promising tools for the early diagnosis, monitoring and personalized treatment of AD. As research continues to evolve, the integration of these biomarkers into clinical practice holds the potential to improve patient outcomes and quality of life. Overcoming the current challenges and leveraging cutting-edge technologies will be crucial in realizing the full potential of biomarkers in the management of atopic dermatitis.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Bhangoo, R.S., T.W. Cheng, M.M. Petersen and C.S. Thorpe, et al. "Radiation recall dermatitis: A review of the literature." Semin Oncol 49 (2022): 152-159.

Google Scholar, Crossref, Indexed at

2. Delanian, Sylvie, Raphael Porcher, Saida Balla-Mekias and Jean-Louis Lefaix, et al. "Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis." J Clin Oncol 21 (2003): 2545-2550. 

Google Scholar, Crossref, Indexed at

3. Hwang, In Gyu, Jung Hun Kang, Sung Yong Oh and Suee Lee, et al. "Phase II trial of epidermal growth factor ointment for patients with erlotinib-related skin effects." Support Care Cancer 24 (2016): 301-309.

Google Scholar, Crossref, Indexed at

4. Bernerd, Françoise, Thierry Passeron, Isabelle Castiel and Claire Marionnet, et al. "The damaging effects of long UVA (UVA1) rays: a major challenge to preserve skin health and integrity." Int J Mol Sci 23 (2022): 8243.

Google Scholar, Crossref, Indexed at

5. Mittal, Shankila, Niti Khunger and Satya Pal Kataria. "Nail changes with chemotherapeutic agents and targeted therapies." Indian Dermatol Online J 13 (2022): 13-22.

Google Scholar, Crossref, Indexed at

6. Lacouture, Mario E., Shenhong Wu, Caroline Robert and Michael B. Atkins, et al. "Evolving strategies for the management of hand–foot skin reaction associated with the multitargeted kinase inhibitors sorafenib and sunitinib." Oncologist 13 (2008): 1001-1011.

Google Scholar, Crossref, Indexed at