THE ROLE OF IMMUNOLOGICAL DISORDERS IN THE DEVELOPMENT OF ATOPIC DERMATITIS

The basis for the development of atopic dermatitis (AtD) is a complex interaction between genetic disorders, environmental factors, lack of the skin barrier and immunological disorders. In view of the importance of immunological disorders in the etiopathogenesis of atopic dermatitis, the study of these parameters in patients with AtD is a necessary aspect to assess the severity of the course, prognosis of complications and recurrence.

Purpose. Comprehensive assessment of clinical and immunological parameters in adolescents with atopic dermatitis.

Materials and methods. The study included examination of 28 patients with atopic dermatitis aged from 12 to 16 years, with disease duration from 10 to 15 years, which included analysis of complaints and anamnesis data, evaluation of disease severity on the SCORAD scale, General clinical and immunological studies. The peculiarities of cellular and humoral immunity in the relapse stage were determined. The main indicators of phagocytic activity of blood neutrophils were also investigated.

Results. In the analysis of anamnestic data of patients, a history of diseases associated with atopia in 16 (57.1%) of 28 adolescents (AtD, bronchial asthma in relatives of the first and second line of kinship) was revealed. When assessing the disease severity on a scale of SCORAD, prevailed patients with moderate to severe atopic dermatitis over — 19 (67,9%) patients, the average score of the assessment of the severity of AtD amounted to 29.3 ± 1,25. The conducted immunological examination with assessment of cellular and humoral immunity showed significant changes in immunological reactivity in patients with AtD. On the part of the cellular immunity level it is necessary to note a clear decrease in CD3+ and CD8⁺, as well as an increase in the subpopulation of T-lymphocytes — CD4⁺ and b-lymphocytes — CD20⁺ in most patients compared to normal indicators characteristic of this age group. Compared to healthy adolescents, there were high rates of IRA and NK cells (CD16⁺). In all patients there was an increase in immunoglobulin M and G, a high content of immunoglobulin E. The formation of secondary immunodeficiency, manifested by a decrease in phagocytic activity of leukocytes and incomplete phagocytosis, which is a factor predisposing to the development of pyoderma.

Conclusion. Changes in immune status in patients with AtD are expressed by imbalance of population Of T-lymphocytes, increase of various classes of immunoglobulins and considerable oppression of practically all indicators of functional activity of neutrophils of blood.

patients, adolescents, atopic dermatitis, immune status, humoral immunity, atopic conditions

1. Al’banova VI, Pampura AN. Atopicheskii dermatit [Atopic dermatitis]. Мoscow: “Geotar-Media” Publ., 2014, 128 p. (In Russian).

2. Federal’nye klinicheskie rekomendatsii. Dermatovenerologiya 2015: Bolezni kozhi. Infektsii, peredavaemye polovym putem [Federal clinical guidelines. Dermatovenereology 2015. Diseases of the skin. Sexually transmitted infections]. 5th ed. Мoscow: “Delovoi ekspress” Publ., 2016, 768 p. (In Russian)

3. Kindeeva ET, Varlamov EE, Pampura AN. The functional status of the skin barrier in children with atopic dermatitis. Russian Allergology Journal. 2013;1:52–7. (In Russian)

4. Tamrazova OB, Stadnikova AS. New ideas about etiopathogenesis atopic dermatitis and tactics of patients. Consilium Medicum. 2015;1:64–9. (In Russian)

5. Pawankar R, Canonica GW, Holgate ST, et al. The World Allergy Orgamization White Book on Allergy (Update. 2013).

6. Allergologiya i immunologiya [Allergology and Immunology]. Edited by Baranov AA, Haitov RF. 2nd ed. Мoscow: The Union of pediatricians of Russia, 2010, 248 p. (In Russian)

7. Reitamo S, Luger T, Steinhoff M. Textbook of atopic dermatitis. Informa, 2008, 569 p.

8. Rahman S, Collins М, Williams CM. The pathology and immunology of atopic dermatitis. Infl amm Allergy Drug Targets. 2011 Dec;10 (6):486–96. DOI: 10.2174/187152811798104935

9. Leyvraz C, Charles RP, Rubera I, Guitard M, Rotman S, Breiden B, et al. The epidermal barrier function is dependent on the serine protease CAP1/Prss8. J Cell Biol. 2005 Aug 1;170 (3):487–96. DOI: 10.1083/jcb.200501038

10. Paternoster L, Standl M, Waage J, Baurecht H, Hotze M, Strachan DP, et al. Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifi es new risk loci for atopic dermatitis. Nat Genet. 2015 Dec;47 (12):1449–1456. DOI: 10.1038/ng.3424

11. Keniksfest YuV, Kungurov NV, Kokhan MM. Vzaimosvyaz’ klinicheskikh proyavlenii i immunologicheskikh parametrov pri razlichnykh tipakh techeniya AD u detei. Klinitceskaya dermatologiya i venerologiya (The Russian Journal of Dermatology and Venereology). 2004;1:40–2. (In Russian)

12. Kokhan MM, Keniksfest YuV, Hovikov GM. Effi ciency of combined application of external therapy and skin moistening in patients with atopic dermatitis. Vestnik Dermatologii i Venerologii. 2007;4:55–60. (In Russian)

13. Hoste E, Kemperman P, Devos M, Denecker G, Kezic S, Yau N, et al. Caspase-14 is required for filaggrin degradation to natural moisturizing factors in the skin. J Invest Dermatol. 2011 Nov;131 (11):2233–41. DOI: 10.1038/jid.2011.153

14. Kawasaki H, Nagao K, Kubo A, Hata T, Shimizu A, Mizuno H, et al. Altered stratum corneum barrier and enhanced percutaneous immune responses in filaggrin-null mice. J Allergy Clin Immunol. 2012 Jun;129 (6):1538–46.e6. DOI: 10.1016/j.jaci.2012.01.068.