Skin Barrier Dysfunction in Infants’ Cheeks May Predict Atopic Dermatitis Development

A study revealed infants who develop atopic dermatitis have skin barrier dysfunction in cheeks with delayed FLG processing, decreased protein-bound ceramides, and increased IL-18.1 The research will be presented at the 2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting in San Diego from February 28 – March 3.

Previous studies have shown changes in the forearm skin barrier before atopic dermatitis onset in infants 2 months old. A study published last April demonstrated changes in skin barrier proteins in infants, such as lipid metabolism, immune profiles, and the microbiome, explained why some infants progress to clinical atopic dermatitis.2

However, changes in the cheek skin barrier before the development of atopic dermatitis had yet to be examined. This prompted investigators, led by Jessica Hui-Beckman, MD, from the National Jewish Health, to assess for cheek skin changes before atopic dermatitis onset.1

The study enrolled pregnant woman and evaluated their infants during the first month of life (birth visit) and at 3 months. Infants were then followed for a year for an atopic dermatitis diagnosis.

At each visit, investigators collected transepidermal water loss and 4 skin tape strips on the cheek. The skin tape strip extracts were analyzed using liquid chromatography-tandem mass spectrometry to quantify filaggrin breakdown products and lipids. They also examined cytokines using U-plex MesoScale Discovery assays.

Among 18 babies, 8 developed atopic dermatitis. Children who developed atopic dermatitis had significantly increased transepidermal water loss from the birth visit (P < .05). Moreover, FLG breakdown products, such as sis-UCA, were significantly lower at birth (P < .05) and 3 months (P = .0784) for children who later developed atopic dermatitis.

Additionally, amino acids originating from FLG, such as histidine (P < .05) and glutamine (P < .05 and P < .01) acid, were significantly lower at birth and 3 months, respectively, for children who developed atopic dermatitis. These children also had significantly decreased levels of protein-bound ceramides at 3 months (P < .05). Furthermore, IL-18 was significantly increased at birth and even greater at 3 months (P < .01) for children who developed atopic dermatitis.

“Early life cheek skin of children who develop [atopic dermatitis] have skin barrier dysfunction with delayed FLG processing, decreased protein-bound ceramides, and elevated IL-18 suggesting that the cheek is vulnerable for allergen sensitization,” investigators wrote.

References

1. Hui-Beckmann, J, Goleva, E, Bronoff, A, et al. Early Life Cheek Skin Barrier Changes are Associated with Atopic Dermatitis Development. Poster will be presented at the AAAAI 2025 meeting in San Diego from February 28 – March 3.

2. Paller AS, Scharschmidt TC, Kezic S, Irvine AD. Preclinical Atopic Dermatitis Skin in Infants: An Emerging Research Area. J Invest Dermatol. 2024 May;144(5):1001-1009. doi: 10.1016/j.jid.2024.02.021. Epub 2024 Apr 3. PMID: 38573278.