Genotypic and demographic factors of the therapy effectiveness in different phenotypic trajectories of atopic dermatitis in children
Year: 2026
Type: article
Study design: Observational Study
Abstract: Genetic predisposition, sex, and age at disease onset play an important role in the pathogenesis of atopic dermatitis (AD) and the effectiveness of its treatment in children. To date, insufficient data are available regarding the influence of these factors on changes in clinical symptoms’ dynamics (CSD) of AD during standard therapy (ST). The aim of this study was to determine the role of different genotypes of the single nucleotide variant (SNV) rs7927894 of the filaggrin (FLG) gene, sex, and age in the effectiveness of standard therapy, as assessed by changes in CSD across different phenotypic trajectories (PhT) of atopic dermatitis in children. The study group comprised 29 children divided into three subgroups: 9 children with a mono-organ PhT (MOPhT) of AD, 10 children with a poly-organ PhT (POPhT) of AD + allergic rhinitis/rhinoconjunctivitis (AR/ARC), and 10 children with a poly-organ POPhT representing a completed atopic march (AD + AR/ARC + bronchial asthma (BA)). All children in the three subgroups underwent genotyping of buccal swab samples using real-time polymerase chain reaction (qPCR) to determine the C/T, C/C, and T/T genotypes of the SNV rs7927894 of the FLG gene. The Scoring Atopic Dermatitis (SCORAD) index was used to assess clinical symptoms dynamics at the beginning and at the end of follow-up (FU), with values presented as medians and interquartile ranges – Me [LQ-HQ]. The mean FU duration was 1.5 [1.1; 2.0] years (range, 1-2.4 years). Improvement (a decrease in the SCORAD index) during ST for AD was observed significantly more frequently in children aged 7-11 years (86%, p=0.008) and in carriers of the heterozygous C/T genotype of the SNV rs7927894 FLG (75%, p=0.005). In patients with AD MOPhT, whose baseline SCORAD values did not differ significantly (32.2 [14.2; 45.8] and 32.5 [31.4; 43.3], p=0.796), worsening of CSD was observed as an increase of 8.0 points (p=0.108), whereas improvement was detected by a significant decrease in the index of 8.5 points (p=0.043). The final significant difference between worsening and improvement in CSD, as assessed by SCORAD, was 16.8 points (p=0.020).In patients with POPhT of AD + AR/ARC, whose baseline SCORAD values did not differ significantly (29.9 [23.2; 34.8] and 37.2 [27.1; 39.4], p=0.336), worsening of CSD was detected as an increase of 3.4 points (p=0.144), while improvement was detected by a significant decrease in the index of 14.7 points (p=0.028). Following ST, the difference between worsening and improvement in CSD for this PhT of AD was 10.8 points (p=0.055). In patients with POPhT of AD + AR/ARC + BA, whose baseline SCORAD values did not differ significantly (22.8 [14.2; 29.7] and 26.6 [18.5; 51.2], p=0.569), worsening of CSD was detected as an increase in the index of 6.3 points (p=0.109), whereas improvement was demonstrated by a significant decrease of 12.3 points (p=0.028). Following ST, the difference between worsening and improvement in CSD for this PhT of AD was statistically significant at 14.8 points (p=0.038). Standard therapy for AD is most frequently effective in improving the clinical symptoms dynamics among patients aged 7-11 years. The heterozygous C/T genotype of the SNV rs7927894 FLG is most frequently associated with the effectiveness of standard therapy in improving the clinical symptoms dynamics of AD, in 75% of patients. A more precise assessment of the effectiveness of standard therapy on the clinical symptoms dynamics in children with mono-organ and poly-organ phenotypic trajectories of AD requires investigation of the maximal spectrum of genotypic and demographic factors in larger patient cohorts, at the background of using the combinations of follow-up assessment tools.
Source: Medicni perspektivi
Institution: Dnipro State Medical University
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223554168