Using sticky strips to harmlessly collect cells from the uppermost layer of a baby’s skin just weeks after birth can identify their risk of developing eczema many months later, researchers report.
Lipid and cytokine levels in the stratum corneum at the age of two months were able to identify children that went on to develop atopic dermatitis (AD)—the most common form of eczema—at two years of age.
The findings, in the Journal of Allergy and Clinical Immunology, could enable the early implementation of preventive treatments such as emollients and biologics.
The researchers say their results open up the field of AD to precision medicine and raise expectations that the “atopic march” can be prevented.
“The holy grail to deal with atopic dermatitis is to prevent it,” explained senior researcher Donald Leung, PhD, head of pediatric allergy and clinical immunology at the National Jewish Center in Denver, Colorado.
“It tends to come back when you treat it, so we really have to examine how to avoid getting it.”
AD affects nearly 30 percent of children worldwide and significantly impacts the quality of life of both those affected and their families.
To identify biomarkers that could potentially identify those at later risk, researchers used skin tape strips (STS) to collect forearm stratum corneum samples from 111 babies aged two months in Seoul, South Korea, before any AD signs were seen.
The samples were analyzed by liquid chromatography electrospray ionization tandem mass spectrometry for a wide panel of lipid molecules.
Samples also underwent cytokine analysis to gain an insight into mechanisms involved in skin barrier function and local immune responses.
Among 74 babies identified as at risk for AD through a family history of the allergic diseases or who had parents that responded to a skin-prick allergen test, 29.7 percent went to develop atopic dermatitis by two years of age.
This compared with just 13.5 per cent of the 37 infants who were not identified at risk of the skin condition.
Children who went on to develop AD had significantly decreased levels of protein-bound ceramides and increased levels of unsaturated sphingomyelin species, ‘short-chain’ non-hydroxy and alpha-hydroxy fatty acid sphingosine ceramides.
Furthermore, thymic stromal lymphopoietin (TSLP) and interleukin (IL-)13 levels were increased by 74.5% and 78.3%, respectively, in children who went on to develop AD compared with others.
Multivariable logistic regression analysis revealed that the combination of family history, type 2 cytokines, and dysregulated lipids strongly predicted future atopic dermatitis.
When taken together, the predictive power of family history and changes in type 2 cytokines, omega-hydroxy fatty acid sphingosine ceramides, and unsaturated sphingomyelin or alpha-hydroxy fatty acid sphingosine ceramides reached odds ratios of between 20 and 54.
“Our results highlight novel skin biomarkers of the future of AD onset that, when combined, provide an unprecedented power of prediction and open the field of precision medicine in AD,” the researchers maintain.
They add: “The non-invasive method of [stratum corneum] collection using STS is safe to use even on the skin of newborn children that, together with a possibility to use targeted biologics, brings strong expectation that atopic diseases and the atopic march can be prevented.”
