THE ROLE OF CONDITIONALLY PATHOGENIC FUNGAL STRAINS IN THE COURSE OF ATOPIC DERMATITIS IN CHILDREN
About the author:
Nedelska S. M., Vakula D. O., Pakholchuk O. P.
Type of article:
Atopic dermatitis (AD) is a chronic recurrent inflammation of the skin with a prevalence 10-15% in children worldwide. The pathogenesis of AD is complex and insufficiently studied. Patients with AD are sensitive to viral, bacterial and fungal skin infections, because of the skin barrier function defection in an acute period. Irreversible changes of the skin barrier structure and transformation of the skin microbiota, excessive overgrowth of bacteria and fungi lead to chronization of AD. Early detection of the skin superinfection in AD may prevent chronization in early childhood. The purpose is to study the role of conditionally pathogenic fungal strains in the course of AD in children. Methods. 98 children with AD (age 3 months – 3 years) were. Transepidermal water loss, skin pH meas-urements and microbiological study were performed. Results. A group of 56 children among the 98 patients with AD had signs of a complicated course of AD due to rash and its localization, as well as the ineffective therapy with moisturizers, anti-inflammatory drugs and elimination diet, which is the first stage in the AD treatment according to the ICON recommendations. This rash was regarded as a possible fungal superinfection. 12 children out of the 56 had microbiologically confirmed contamination with fungi: Candida albicans (n = 6), Candida nonalbicans (n = 3), Hormodendrum compactum (n = 2), Aspergillus nidulans (n = 1). Detection of Spp. Malassezia did not give positive results. 89% of the children (n = 50) had verified changes of the skin pH (<5.5 or >5.8). The patients with nontypical rash, changed pH (<5.5 and > 5.8) had an effective treatment with antifungul drugs and achieved remission in AD. Conclusion. Morphologically altered elements of moderate to severe rash should be regarded as a possible fungal super infection. Revealed changes in the skin pH and the background of altered clinical manifestations of AD (peeling spots with raised or scalloped edge, double contour, clear demarcated, cracks with blood secretion) should be regarded as activation of fungal microorganisms which is considered to be ethiotropically treated due to the guidelines.
children, atopic dermatitis, conditionally pathogenic strains.
- Zhang E, Tanaka T, Tajima M, Tsuboi R, Nishikawa A, Sugita T. Characterization of the skin fungal microbiota in patients with atopic dermatitis and in healthy subjects. Microbiology and Immunology. 2011;55(9):625-32.
- Bjerre RD, Bandier J, Skov L, Engstrand L, Johansen JD. The role of the skin microbiome in atopic dermatitis: a systematic review. British Journal of Dermatology. 2017;177(5):1272-8.
- Hoog S, Monod М, Dawson Т, Boekhout T, Mayser P, Graser Y. The Fungal Kingdom. American Society for Microbiology, Washington; 2018. Chapter 41, Skin Fungi from Colonizationto Infection. p. 855-66.
- Kong Н, Oh О, Deming Cl, Conlan S, Grice E, Beatson M, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012;22(5):850-9.
- Mittermann I, Wikberg G, Johansson C, Lupinek C, Lundeberg L, Crameri R, et al. IgE Sensitization Profiles Differ between Adult Patients with Severe and Moderate Atopic Dermatitis. PLoS One. 2016;11(5). DOI: 10.1371/journal.pone.0156077
- Crameri R, Garbani M, Rhyner C, Huitema C. Fungi: the neglected allergenic sources. Allergy. 2014;69:176-85.
- Xu F, Yan S, Li F, Cai M, Chai W, Wu M, et al. Prevalence of childhood atopic dermatitis: an urban and rural community based study in Shanghai, China. PLoS ONE. 2012;7. DOI: 10.1371/journal.pone.0036174
- Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006;19:296- 302.
- Rippke F, Berardesca E, Weber TM. pH and Microbial Infections. Current Problems in Dermatology. 2018;54:87-94.
- Surber C, Abels C, Maibach H. pH of the Skin: Issues and Challenges. Curr Probl Dermatol. Basel, Karger, 2018. 54, 206 р.
- Atopichnyy dermatyt: adaptovana klinichna nastanova, zasnovana na dokazakh. Derzhavnyy ekspertnyy tsentr MOZ Ukrayiny; 2016. 112 s. [in Ukrainian].
- Leung1 DYM. New Insights into Atopic Dermatitis: Role of Skin Barrier and Immune Dysregulation. Allergology International. 2013;62:151- 61.
- Pakholchuk OP. Transepidermal water lost as the earliest independent marker of the epidermal barrier dysfunction in children with food hypersensitivity. Clinical and Experimental Medical Sciences. 2018;6:25-32. 13.Du Plessis JL, Stefaniak AB, Wilhelm KP. Measurement of Skin Surface pH. Current Problems in Dermatology. 2018;54:19-25.
- Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PhA, Ebisawa M, et al. ICON: food allergy. J. Allergy Clin. Immunol. 2012;129:906- 20.
- Hoppe T, Winge MC, Bradley M, Nordenskjöld M, Vahlquist A, Törmä H, Berne B. Moisturizing treatment of patients with atopic dermatitis and ichthyosis vulgaris improves dry skin, but has a modest effect on gene expression regardless of FLG genotype. J. Eur. Acad. Dermatol. Venereol. 2015 Jan;29(1):174-7.
- Kezic S, Novak N, Jakasa I, Jungersted JM, Simon M, Brandner JM, et al. Skin barrier in atopic dermatitis. Front. Biosci. 2014 Jan 1;19:542-56.
Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (157), 2020 year, 287-293 pages, index UDK 616.516:[576.882.8.063.8:616-092]-053.2-036