Phenotypes of atopic dermatitis: stratification by severity and in vivo assessment of filaggrin protein levels

Abstract

Background. Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial pathogenesis and marked clinical heterogeneity. A comprehensive assessment combining demographic and clinical-history data, objective biomarkers, and atopic comorbidities expands the possibilities for personalized care.

Aim. To stratify patients with atopic dermatitis according to severity based on clinical and anamnestic data and filaggrin protein levels.

Materials and methods. In a single-centre prospective study, disease severity was determined using the Investigator’s Global Assessment (IGA) score, and filaggrin expression was determined using tape stripping followed by immunohistochemical analysis. Demographic characteristics, data on atopic comorbidities, and family history of atopy were also collected.

Results. Ninety patients were included; moderate and severe severity prevailed (36/90 and 34/90). Onset in childhood was more common in IGA 3/4 (30/34 in the severe group; 14/36 in the moderate group). Filaggrin levels differed between groups: median 0.171 [0.107; 0.254] in the severe group and 0.499 [0.339; 1.038] in the moderate group; in IGA 1–2, the values were higher (0.415 [0.372; 0.458] and 0.433 [0.191; 0.618]).

Conclusion. The phenotypic profile of patients with AD changes significantly as the disease worsens and is associated with age of onset, atopic comorbidities, and filaggrin barrier marker levels. Non-invasive assessment of filaggrin using tape stripping has demonstrated technological simplicity and clinical comparability with severity, allowing it to be considered as an additional monitoring tool in clinical practice.