Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis

Abstract Background Atopic dermatitis/AD shows differential clinical presentation in older compared to younger patients. Nevertheless, changes in the AD molecular profile with age are unknown. Objective To characterize age-related changes in the AD profile. Methods We evaluated age-specific changes in lesional and non-lesional tissues and blood from moderate-to-severe AD patients (n=246) and age-matched controls (n=72) using immunohistochemistry, qRT-PCR, and Singulex in a cross-sectional study. Patients were analyzed using age-groups (18-40, 41-60, and 61+ years old). Results While disease severity/SCORAD was similar across AD age-groups (mean:∼60; P=0.873), dendritic cell infiltrates (CD1b + , FceRI + ; P H 2 measures (IL-5, IL-13, CCL13, CCL18, CCL26) significantly decreased with age in AD, despite increasing with age in controls. Consistent with T H 2 axis decreases, serum IgE and eosinophils negatively correlated with age in AD ( r =-0.24, r =-0.23, P H 22-secreted IL-22 also decreased with age uniquely in AD (P H 1- (IFN-γ, IL-12/23p40, STAT1, CXCL9; P H 17-related markers (IL-17A, IL-20; P H 2 downregulation (CCL26; r =-0.32, P H 1 upregulation (IFN-γ; r =0.48, P Conclusion The adult AD profile varies with age. While T H 1/T H 17-skewing decreases in both AD and controls, AD shows unique decreases in T H 2/T H 22 polarization, and normalization of epithelial abnormalities. Thus, age-specific treatment approaches may be beneficial for AD.