Scientist examining a skin cell sample in a lab

Skin Differences in Children and Adults with Atopic Dermatitis

What is different about the skin of infants, children, and adults with and without atopic dermatitis (AD)? This question has been the subject of scientific investigation since personalized treatment regimens have become more available. Targeted therapies devised by dermatologists, histologists and other physicians will benefit from more specific age and disease-related information.

Differing phenotypes

Cellular level examination of the skin has led researchers to determine that the phenotypes of children with early-onset atopic dermatitis differ from those who develop the condition later in life. Early-onset is defined as children from birth up to age 6. Phenotype is the expression of the physical properties of an organism such as appearance and behavior. It is based on genetic building blocks and influenced by the environment.

What is atopic dermatitis?

Atopic dermatitis is an inflammatory skin condition characterized by itchy, scaly skin. AD often appears at a very young age and can be chronic. Management of AD is traditionally based on suppressing inflammation and restoring the functionality of the skin barrier. This results in fewer exacerbations and skin infections.

Atopic dermatitis causes

Researchers continue to investigate what factors contribute to developing AD, at what age, with which specific attributes that may serve as predictors of how it may be best treated and whether it will manifest in the future. Finding answers to these questions may be the next step in personalized medicine. Physicians and patients alike will benefit from being able to achieve the best therapies for AD subtypes, those that can effectively treat or prevent the exacerbation of atopic dermatitis. The study of AD epidemiology and genetics continues to expand the available information about disease origin, progression and the development of atopic march as well as the improved ability to treat patients with the most individualized therapies possible.1

Phenotypes TH2 and TH17

T helper cells (TH) play a role in regulating the immune response system. Studies examining the skin of children with AD, adults with AD and groups without the condition, found there were significant skin tissue differences both in samples with and without lesions. They reflect the properties of the skin’s functional barrier and ability to control inflammation.

Differences in T helper cells

Typical T helper cells involved are TH1, TH2, TH17, and TH22. Researchers determined that adults and children both express TH2 inflammation, and in children there was evidence of TH17 and TH22 expression—but not the TH1 upregulation that is typical of adult AD. The TH17 levels are similar to those in psoriasis patients and may be responsive to a treatment strategy derived from psoriatic cases, according to Emma Gutman from the Ichan School of Medicine at Mount Sinai.1

What do T helper cells do?

T helper cells are involved in the regulation of the immune response system, often characterized by cellular receptor response. Downregulation occurs when a response to a stimulus is reduced or suppressed due to a decrease in the number of receptors on the cell surface. Upregulation involves the increase of a stimulus-response due to the presence of more receptors on the cell surface.

Future treatment development

Treatments for children with early-onset conditions are likely to vary based on the severity of their condition and the histological (cellular) analysis. For some, treating the skin barrier may be enough, for others, Guttman says immunomodulatory interventions (treating the immune system) may be necessary to clear up skin and prevent atopic march.1Immunomodulators are medications that help to regulate or normalize the immune system.

Importance of understanding skin differences

Understanding skin differences, and recognizing genetic and environmental influences, could potentially change the way atopic dermatitis is treated for children under 6.4 Both adults and children had abnormalities in the lipid barriers of their skin.

Researchers believe more work will help determine if identifying changes in the immune system can predict who will develop adult AD, and who might outgrow the condition. The disease development process and its mechanism of action (the way it works) may be responsive to treatments that could result in controlling disease severity and progression.

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