Phenotypes of atopic dermatitis

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Abstract

This review summarizes the current understanding of the phenotypes (clinical manifestations) of atopic dermatitis based on morphological and some laboratory diagnostic tools (total IgE level, sensitization status, filaggrin mutations). The author gives a chronology of the study of atopic dermatitis phenotypes, including the use of modern statistical methods (clusters). Recent studies have described unique phenotypes in patients with atopic dermatitis colonized by Staphylococcus aureus; in patients with atopic dermatitis and food allergies; in patients with herpes eczema, including a history of herpes infection. At the same time, it is quite obvious that phenotypes are determined by molecular mechanisms (endotype), which are associated with the age of patients, the severity of the disease, persistence, etc. Recently, publications have appeared that confirmed the features of the course of the disease in different ethnic groups (European-American and Asian phenotypes), including immunopathogenetic differences characteristic of different races of people.

Together, studies on the endo- and phenotypes of atopic dermatitis will help to better identify the most optimal approach to personalized treatment of these patients. Ultimately, such studies are important for developing a classification of atopic dermatitis phenotypes.

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About the authors

Dali S. Macharadze

Peoples’ Friendship University of Russia

Author for correspondence.
Email: dalim_a@mail.ru
ORCID iD: 0000-0001-5999-7085
SPIN-code: 2399-5783

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

References

  1. Cabanillas B, Brehler AC, Novak N. Atopic dermatitis phenotypes and the need for personalized medicine. Curr Opin Allergy Clin Immunol. 2017;17(4):309–315. doi: 10.1097/ACI.0000000000000376
  2. Kim J, Ahn K. Atopic dermatitis endotypes: Knowledge for personalized medicine. Curr Opin Allergy Clin Immunol. 2022;22(3):153–159. doi: 10.1097/ACI.0000000000000820
  3. Bieber T, D’Erme AM, Akdis CA, et al. Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? J Allergy Clin Immunol. 2017;139(4S):S58–S64. doi: 10.1016/j.jaci.2017.01.008
  4. Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143:1–11. doi: 10.1016/j.jaci.2018.10.032
  5. Bakker DS, Nierkens S, Knol EF, et al. Confirmation of multiple endotypes in atopic dermatitis based on serum biomarkers. J Allergy Clin Immunol. 2021;147:189–198. doi: 10.1016/j.jaci.2020.04.062
  6. Bosma AL, Ascott A, Iskandar R, et al. Classifying atopic dermatitis: A systematic review of phenotypes and associated characteristics. J Eur Acad Dermatol Venereol. 2022;36(6):807–819. doi: 10.1111/jdv.18008
  7. Thijs J, Krastev T, Weidinger S, et al. Biomarkers for atopic dermatitis: A systematic review and meta-analysis. Curr Opin Allergy Clin Immunol. 2015;15(5):453–460. doi: 10.1097/ACI.0000000000000198
  8. Chopra R, Vakharia PP, Sacotte R, et al. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol. 2017;177(5):1316–1321. doi: 10.1111/bjd.15641
  9. Amat F, Saint-Pierre P, Bourrat E, et al. Early-onset atopic dermatitis in children: Which are the phenotypes at risk of asthma? Results from the ORCA cohort. PLoS One. 2015;10(6):e0131369. doi: 10.1371/journal.pone.0131369
  10. Lee E, Lee SH, Kwon JW, et al. Atopic dermatitis phenotype with early onset and high serum IL-13 is linked to the new development of bronchial hyperresponsiveness in school children. Allergy. 2016;71(5):692–700. doi: 10.1111/all.12844
  11. Roduit C, Frei R, Depner M, et al. Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood. JAMA Pediatr. 2017;171(7):655–662. doi: 10.1001/jamapediatrics.2017.0556
  12. Paternoster L, Savenije OE, Heron J, et al. Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts. J Allergy Clin Immunol. 2018;141(3):964–971. doi: 10.1016/j.jaci.2017.09.044
  13. Seo E, Yoon J, Jung S, et al. Phenotypes of atopic dermatitis identified by cluster analysis in early childhood. J Dermatol. 2019;46(2):117–123. doi: 10.1111/1346-8138.14714
  14. Yum HY, Lee JS, Bae JM, et al. Classification of atopic dermatitis phenotypes according to allergic sensitization by cluster analysis. World Allergy Organ J. 2022;15(8):100671. doi: 10.1016/j.waojou.2022.100671
  15. Bieber T. Atopic dermatitis 2.0: From the clinical phenotype to the molecular taxonomy and stratified medicine. Allergy. 2012;67: 1475–1482. doi: 10.1111/all.12049
  16. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980;92:44–47.
  17. Williams HC, Burney PG, Pembroke AC, et al. Working party’s diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131(3):406–416. doi: 10.1111/j.1365-2133.1994.tb08532
  18. Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–351. doi: 10.1016/j.jaad.2013.10.010
  19. Bozek A, Fisher A, Filipowska B, et al. Clinical features and immunological markers of atopic dermatitis in elderly patients. Int Arch Allergy Immunol. 2012;157:372–378. doi: 10.1159/000329150
  20. Girolomoni G, de Bruin-Weller M, Aoki V, et al. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis. 2021;12:20406223211002979. doi: 10.1177/20406223211002979
  21. Chovatiya R, Lei D, Ahmed A, et al. Clinical phenotyping of atopic dermatitis using combined itch and lesional severity: A prospective observational study. Ann Allergy Asthma Immunol. 2021;127(1): 83–90. doi: 10.1016/j.anai.2021.03.019
  22. Mulick AR, Allen V, Williams HC, et al. Classifying atopic dermatitis: Protocol for a systematic review of subtypes (phenotypes) and associated characteristics. BMJ Open. 2018;8(9):e023097. doi: 10.1136/bmjopen-2018-023097
  23. Elisyutina OG. Clinical phenotypes and molecular genetic characteristics of endotypes of atopic dermatitis [dissertation abstract]. Moscow; 2019. 28 p. (In Russ).
  24. Schmid-Grendelmeier P, Simon D, Simon HU, et al. Epidemiology, clinical features, and immunology of the “intrinsic” (non-IgE-mediated) type of atopic dermatitis (constitutional dermatitis). Allergy. 2001;56(9):841–849. doi: 10.1034/j.1398-9995.2001.00144
  25. Tokura Y. Extrinsic and intrinsic types of atopic dermatitis. J Dermatol Sci. 2010;58(1):1–7. doi: 10.1016/j.jdermsci.2010.02.008
  26. Fania L, Moretta G, Antonelli F, et al. Multiple roles for cytokines in atopic dermatitis: From pathogenic mediators to endotype-specific biomarkers to therapeutic targets. Int J Mol Sci. 2022;23(5):2684. doi: 10.3390/ijms23052684
  27. Casagrande BF, Flückiger S, Linder MT, et al. Sensitization to the yeast Malassezia sympodialis is specific for extrinsic and intrinsic atopic eczema. J Invest Dermatol. 2006;126(11):2414–2421. doi: 10.1038/sj.jid.5700431
  28. Novembre E, Cianferoni A, Lombardi E, et al. Natural history of “intrinsic” atopic dermatitis. Allergy. 2001;56(5):452–453. doi: 10.1034/j.1398-9995.2001.056005452
  29. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol. 2004;114(1):150–158. doi: 10.1016/j.jaci.2004.04.027
  30. Ott H, Wilke J, Baron JM, et al. Soluble immune receptor serum levels are associated with age, but not with clinical phenotype or disease severity in childhood atopic dermatitis. J Eur Acad Dermatol Venereol. 2010;24(4):395–402. doi: 10.1111/j.1468-3083.2009.03419
  31. Hu Y, Liu S, Liu P, et al. Clinical relevance of eosinophils, basophils, serum total IgE level, allergen-specific IgE, and clinical features in atopic dermatitis. J Clin Lab Anal. 2020;34(6):e23214. doi: 10.1002/jcla.23214
  32. Brenninkmeijer EE, Spuls PI, Legierse CM, et al. Clinical differences between atopic and atopiform dermatitis. J Am Acad Dermatol. 2008;58(3):407–414. doi: 10.1016/j.jaad.2007.12.002
  33. Chung Y, Kwon JH, Kim J, et al. Retrospective analysis of the natural history of atopic dermatitis occurring in the first year of life in Korean children. J Korean Med Sci. 2012;27(7):723–728. doi: 10.3346/jkms.2012.27.7.723
  34. Nissen S, Kjaer H, Høst A, et al. The natural course of sensitization and allergic diseases from childhood to adulthood. Pediatr Allergy Immunol. 2013;24(6):549–555. doi: 10.1111/pai.12108
  35. Schoos A, Chawes B, Rasmussen M, et al. Atopic endotype in childhood. J Allergy Clin Immunol. 2016;137(3):844–851. doi: 10.1016/j.jaci.2015.10.004
  36. Belgrave DC, Granell R, Simpson A, et al. Developmental profiles of eczema, wheeze, and rhinitis: Two population-based birth cohort studies. PLoS Med. 2014;11:e1001748. doi: 10.1371/journal.pmed.1001748
  37. Pinart M, Benet M, Annesi-Maesano I, et al. Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: A population-based cohort study. Lancet Respir Med. 2014;2:131–140. doi: 10.1016/S2213-2600(13)70277-7
  38. Haider S, Fontanella S, Ullah A, et al. STELAR/UNICORN investigators. Evolution of eczema, wheeze, and rhinitis from infancy to early adulthood: Four birth cohort studies. Am J Respir Crit Care Med. 2022;206(8):950–960. doi: 10.1164/rccm.202110-2418OC
  39. Stefanovic N, Flohr C, Irvine AD. The exposome in atopic dermatitis. Allergy. 2020;75(1):63–74. doi: 10.1111/all.13946
  40. Drislane C, Irvine A. The role of filaggrin in atopic dermatitis and allergic disease. Ann Allergy Asthma Immunol. 2020;124:36–43. doi: 10.1016/j.anai.2019.10.008
  41. Irvine A, McLean W, Leung D. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011;365(14): 1315–1327. doi: 10.1056/NEJMra1011040
  42. Ferreira М, Vonk J, Baurecht H, et al. Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology. Nat Genet. 2017;49:1752–1757. doi: 10.1038/ng.3985
  43. Strid J, Hourihane J, Kimber I, et al. Disruption of the stratum corneum allows potent epicutaneous immunization with protein antigens resulting in a dominant systemic Th2 response. Eur J Immunol. 2004;34(8):2100–2109. doi: 10.1002/eji.200425196
  44. Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071–1078. doi: 10.1016/j.jaci.2015.10.049
  45. Wen HC, Czarnowicki T, Noda S, et al. Serum from Asian patients with atopic dermatitis is characterized by TH2/TH22 activation, which is highly correlated with nonlesional skin measures. J Allergy Clin Immunol. 2018;142(1):324–328. doi: 10.1016/j.jaci.2018.02.047
  46. Sanyal RD, Pavel AB, Glickman J, et al. Atopic dermatitis in African American patients is TH2/TH22-skewed with TH1/TH17 attenuation. Ann Allergy Asthma Immunol. 2019;122(1):99–110.e6. doi: 10.1016/j.anai.2018.08.024
  47. Meylan P, Lang C, Mermoud S, et al. Skin colonization by Staphylococcus aureus precedes the clinical diagnosis of atopic dermatitis in infancy. J Invest Dermatol. 2017;137(12):2497–2504. doi: 10.1016/j.jid.2017.07.834
  48. Simpson E, Villarreal M, Jepson B, et al. Patients with atopic dermatitis colonized with Staphylococcus aureus have a distinct phenotype and endotype. J Invest Dermatol. 2018;138(10): 2224–2233. doi: 10.1016/j.jid.2018.03.1517
  49. Damour A, Garcia M, Seneschal J, et al. Eczema herpeticum: Clinical and pathophysiological aspects. Clin Rev Allergy Immunol. 2020;59(1):1–18. doi: 10.1007/s12016-019-08768-3
  50. Beck L, Boguniewicz M, Hata T, et al. Phenotype of atopic dermatitis subjects with a history of eczema herpeticum. J Allergy Clin Immunol. 2009;124(2):260–269. doi: 10.1016/j.jaci.2009.05.020
  51. Ma C, Stinson J, Zhang Y, et al. Germline hypomorphic CARD11 mutations in severe atopic disease. Nat Genet. 2017;49:1192–1201. doi: 10.1038/ng.3898
  52. Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: Diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91–101. doi: 10.1016/j.jaip.2019.06.044
  53. Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int. 2022;71(1):14–24. doi: 10.1016/j.alit.2021.07.003

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