Unraveling heterogeneity in pediatric atopic dermatitis

Published: July 5, 2021

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases worldwide. Increasing evidence shows that pediatric AD differs from adult AD on a biological level. Different subgroups of adult AD patients have previously been identified based on their distinct underlying pathophysiological mechanisms. However, heterogeneity on a biological level has not yet been confirmed in pediatric AD, and broad blood profiling in all age ranges of pediatric AD patients is limited.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Bakker et al. measured 145 biomarkers in serum from 240 AD children (aged 0–17 years). By using a data-driven approach, pediatric AD patients were divided into different biomarker-based patient clusters. Patients were stratified into age groups (0-4 years, 5-11 years, and 12-17 years) to assess association between age and cluster membership.

The authors could identify four pediatric AD patient clusters based on distinct serum biomarker profiles (Th2/retinol dominant”, “skin-homing dominant”, “Th1/Th2/Th17/IL-1 dominant”, and “Th1/IL-1/eosinophil inferior” cluster). Pediatric AD clusters were influenced by disease severity, and not by age or age of onset. Only the “Th1/Th2/Th17/IL-1 dominant” cluster was comparable to one of the previously identified adult AD clusters.

By using an unsupervised profiling approach, the findings of this study indicate that pediatric AD is a biologically heterogeneous disease. The identification of endotypes driven by distinct underlying immunopathological pathways might be useful to define pediatric AD patients at risk of persistent disease and may necessitate different targeted treatment approaches.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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