Antioxidant defense of children and adolescents with atopic dermatitis: Association with disease severity
Main Article Content
Keywords
Adolescent, Antioxidant Defense, Atopic Dermatitis, Child, Oxidative Stress
Abstract
Background: Atopic dermatitis (AD) is a relapsing, chronic cutaneous inflammatory disease with onset, in general, in early childhood. Chronic skin inflammation is associated with overproduction of reactive oxygen species (ROS) such as superoxide and hydrogen peroxide. Oxidative stress, an imbalance between the production of free radicals and antioxidant defense, results in tissue inflammation due to the upregulation of genes that encode inflammatory cytokines. This condition plays an important role in the pathogenesis of AD.
Objective: To compare the antioxidant defense in children and adolescents with AD with that of healthy individuals and to verify the association of antioxidant defense with disease severity and nutritional status.
Methods: Cross-sectional study that evaluated 48 children and adolescents with AD and 25 controls for nutritional assessment (body mass index z score [BMIZ] and height for age z score [HAZ]) and levels of vitamins A, C, E, and D, zinc (Zn), copper (Cu), antioxidant enzymes (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx]), high-sensitivity C-reactive protein (CRP) and interleukin 33 (IL-33).
Results: There was no significant difference in the comparison between AD and control groups for serum levels of vitamins (A, D, C, and E), copper, and antioxidant enzymes. Serum zinc levels were higher in the AD group (β = 24.20; 95% CI 13.95–34.91; P < 0.001) even after adjusting the BMIZ, HAZ, gender, IL-33, and CRP. Children and adolescents with moderate or severe AD compared to mild AD (SCORAD – 36.7±17.4 vs 11.8 ± 3.9; P < 0.001) had lower values of the vitamin E/total lipid ratio (3.68 [0.29;12.63] vs 5.92 [3.27;17.37]; P = 0.013).
Conclusion: Children and adolescents with AD had higher concentrations OF elevated levels of zinc compared to controls, a fact not observed for other biomarkers of antioxidant defense. AD in moderate or severe forms presented lower concentrations of vitamin E, a potent antioxidant fat soluble.
References
2. Makowska K, Nowaczyk J, Blicharz L, Waśkiel-Burnat A, Czuwara J, Olszewska M, et al. Immunopathogenesis of atopic dermatitis: Focus on interleukins as disease drivers and therapeutic targets for novel treatments. Int J Mol Sci. 2023; 24(1):781. 10.3390/ijms24010781
3. Zheng C, Shi Y, Zou Y. T cell co-stimulatory and co-inhibitory pathways in atopic dermatitis. Front Immunol. 2023;14: 1081999. 10.3389/fimmu.2023.1081999
4. Bertino L, Guarneri F, Cannavò SP, Casciaro M, Pioggia G, Gangemi S. Oxidative stress and atopic dermatitis. Antioxidants (Basel). 2020;9(3):196. 10.3390/antiox9030196
5. Bickers DR, Athar M. Oxidative stress in the pathogenesis of skin disease. J Invest Dermatol. 2006;126(12):2565–75. 10.1038/sj.jid.5700340
6. Addor FAS. Antioxidants in dermatology. An Bras Dermatol. 2017; 92(3):356–62. 10.1590/abd1806-4841.20175697
7. Wen HJ, Wang SL, Chen PC, Guo YL. Prenatal perfluorooctanoic acid exposure and glutathione s-transferase T1/M1 genotypes and their association with atopic dermatitis at 2 years of age. PLoS One. 2019;14(1):e0210708. 10.1371/journal.pone.0210708
8. Md Jaffri J. Reactive oxygen species and antioxidant system in selected skin disorders. Malaysian J Med Sci. 2023;30(1):7–20. 10.21315/mjms2023.30.1.2
9. Aranda-Rivera AK, Cruz-Gregorio A, Arancibia-Hernández YL, Hernández-Cruz EY, Pedraza-Chaverri J. RONS and oxidative stress: An overview of basic concepts. Oxygen. 2022;2(4): 437–78. 10.3390/oxygen2040030
10. Hanifin JM, Rajka G. Diagnosis features of atopic dermatitis. Acta Derm Venereol. 1980;92:44–7. 10.2340/00015555924447
11. Oranje AP, Glazenburg EJ, Wolkerstorfer A, et al. Practical issues on interpretation of scoring atopic dermatitis: The SCORAD index, objective SCORAD and three-item severity score. Br J Dermatol. 2007;157(4): 645–8. 10.1111/j.1365-2133.2007.08112.x
12. World Health Organization. WHO AnthroPlus for personal computers manual: Software for assessing growth of the world’s children and adolescents. World Health Organization. 2009.
13. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–7. 10.2471/BLT.07.043497
14. Ashwell M, Cole TJ, Dixon AK. Obesity: New insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J (Clin Res Ed). 1985;290 (6483):1692–4. 10.1136/bmj.290.6483.1692
15. Khoury M, Manlhiot C, McCrindle BW. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol. 2013;62(8):742–51. 10.1016/j.jacc.2013.01.026
16. Kuba VM, Leone C, Damiani D. Is waist-to-height ratio a useful indicator of cardio-metabolic risk in 6–10-year-old children? BMC Pediatr. 2013;13:91. 10.1186/1471-2431-13-91
17. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291–303. 10.1136/adc.44.235.291
18. Peaston RT. Determination of copper and zinc in plasma and urine by atomic absorption spectrophotometry. Med Lab Technol. 1973;30(3):249–53.
19. Whitehouse RC, Prasad AS, Rabbani PI, Cossack ZT. Zinc in plasma, neutrophils, lymphocytes, and erythrocytes as determined by flameless atomic absorption spectrophotometry. Clin Chem. 1982;28(3):475–80. 10.1093/clinchem/28.3.475
20. Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014;134(5):993–9. 10.1016/j.jaci.2014.09.023
21. Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: Diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91–101. 10.1016/j.jaip.2019.06.044
22. Toyran M, Kaymak MVE, Harmanci K, Kaya A, Giniş T, Köse G, et al. Trace element levels in children with atopic dermatitis. J Investig Allergol Clin Immunol. 2012;22(5):341–4.
23. Vaughn AR, Foolad N, Maarouf M, Tran KA, Shi VY. Micronutrients in atopic dermatitis: A systematic review. J Altern Complement Med. 2019;25(6):567–77. 10.1089/acm.2018.0363
24. Karabacak E, Aydin E, Kutlu A, Ozcan O, Muftuoglu T, Gunes A, et al. Erythrocyte zinc level in patients with atopic dermatitis and its relation to SCORAD index. Postepy Dermatol Alergol. 2016;33(5):349–52. 10.5114/ada.2016.62841
25. Ehlayel MS, Bener A. Risk factors of zinc deficiency in children with atopic dermatitis. Eur Ann Allergy Clin Immunol. 2020; 52(1):18–22. 10.23822/EurAnnACI.1764-1489.114
26. David TJ, Wells FE, Sharpe TC, Gibbsi ACC, Devlin J. Serum levels of trace metals in children with atopic eczema. Br J Dermatol. 1990;122(4):485–9. 10.1111/j.1365-2133.1990.tb14725.x
27. Ertunç V, Akçay F, Dane Ş, Akar S, Nasuhbeyoğlu N, Erdem T. Antinuclear antibody positivity in atopic dermatitis. Turk J Med Sci. 1996;26(1):59–61. 10.55730/1300-0144.5270
28. Gray NA, Dhana A, Stein DJ, Khumalo NP. Zinc and atopic dermatitis: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2019;33(6):1042–50. 10.1111/jdv.15524
29. Krebs NF. Update on zinc deficiency and excess in clinical pediatric practice. Ann Nutr Metab. 2013;62 Suppl 1:19–29. 10.1159/000348261
30. Sivaranjani N, Venkata Rao S, Rajeev G. Role of reactive oxygen species and antioxidants in atopic dermatitis. J Clin Diagn Res. 2013;7(12):2683–5. 10.7860/JCDR/2013/6635.3732
31. Jansén CT, Haapalahti J, Hopsu-Havu VK. Immunoglobulin E in the human atopic skin. Arch Dermatol Forsch 1973;246(4): 209–302. 10.1007/BF00595211
32. Tsoureli-Nikita E, Hercogova J, Lotti T, Menchini G. Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: A study of the clinical course and evaluation of the immunoglobulin E serum levels. Int J Dermatol. 2002;41(3):146–50. 10.1046/j.1365-4362.2002.01423.x
33. Jaffary F, Faghihi G, Mokhtarian A, Hosseini SM. Effects of oral vitamin E on treatment of atopic dermatitis: A randomized controlled trial. J Res Med Sci. 2015;20(11):1053–7. 10.4103/1735-1995.172815
34. Teo CWL, Tay SHY, Tey HL, Ung YW, Yap WN. Vitamin E in atopic dermatitis: From preclinical to clinicals. Dermatology. 2021;237(4):553–64. 10.1159/000510653
35. Agón-Banzo PJ, Sanmartin R, García-Malinis AJ, Hernández-Martín Á, Puzo J, Doste D, et al. Body mass index and serum lipid profile: Association with atopic dermatitis in a paediatric population. Australas J Dermatol. 2020;61(1):e60–e64. 10.1111/ajd.13154
36. Kelishadi R, Roufarshbaf M, Soheili S, Payghambarzadeh F, Masjedi M. Association of childhood obesity and the immune system: A systematic review of reviews. Child Obes. 2017;13(4): 332–46. 10.1089/chi.2016.0176
37. Hattangdi-Haridas SR, Lanham-New SA, Sang Wong WH, Hok Kung Ho M, Darling AL. Vitamin D deficiency and effects of vitamin D supplementation on disease severity in patients with atopic dermatitis: A systematic review and meta-analysis in adults and children. Nutrients. 2019;11(8):1854. 10.3390/nu11081854