Adhesive Strips An Alternative to Biopsy for Kids With Atopy?

Jennifer Garcia

October 09, 2019

Tape stripping for cellular marker evaluation provides a new option for monitoring children with atopic dermatitis (AD), according to a study published online October 9 in JAMA Dermatology.

"While this minimally invasive approach can be useful across AD endotypes, it is particularly important for studying pediatric AD skin owing to the impracticality of performing biopsies in children," writes lead author Emma Guttman-Yassky, MD, PhD, from Mount Sinai Medical Center, New York City.

As part of a cross-sectional study, the researchers evaluated 21 children with new-onset (disease duration <6 months) moderate to severe AD and 30 children without AD or a history of personal or family atopy. All patients were younger than 5 years and were enrolled between January 22, 2016, and April 20, 2018. The study excluded those who had used systemic immunosuppressants within 4 weeks of evaluation, those who had recently used topical or systemic steroids, and those who had active skin infections. The Scoring Atopic Dermatitis index (SCORAD), the Eczema Area and Severity Index (EASI), and the Pruritus Atopic Dermatitis Quickscore (ADQ) were used to assess AD severity.

Tape strips were collected from lesional and nonlesional areas from the children with AD and from similar locations from the non-AD group. Samples were evaluated for 15 cellular biomarkers as well as 64 immune and barrier markers previously associated with AD, including markers for general inflammation, epidermal proliferation, and innate immunity.

The researchers found that 77 of the 79 biomarkers evaluated were detected in the tape strip samples and that key inflammatory markers as well as markers for innate immunity were significantly upregulated in children with AD compared with those who did not have AD. Further, biomarkers in lesional skin samples were significantly associated with disease severity and pruritis.

The authors also found that AD biomarkers were present even in the nonlesional skin of patients with early-onset AD, suggesting that this tape-strip evaluation may be useful for evaluating children who are at high risk of developing AD but who do not have obvious lesions.

The investigators acknowledge that mRNA extraction from tape stripping is much more labor intensive than standard biopsy evaluation and that this may limit widespread use of this technique. In addition, they note that some biomarkers cannot be detected in tape strips because they are located below the level of the stratum corneum.

"Because tape stripping is painless, nonscarring, and allows repeated sampling, it may be associated with benefits for longitudinal pediatric studies and clinical trials, in which serial measures are needed to identify predictors of response, course, and comorbidities," conclude Guttman-Yassky and colleagues.

"This study clearly demonstrates that tape stripping in patients with pediatric AD is a viable and useful method for these future studies," writes Leslie Castelo-Soccio, MD, PhD, from the Perelman School of Medicine, University of Pennsylvania, Philadelphia, in an accompanying editorial.

Discussing the growing body of literature that supports tape stripping as a viable diagnostic modality for AD, Castelo-Soccio writes that the current study "stands out for its examination of a robust number of immune and barrier expression differences, protein validation, and use of 2 severity scoring systems (the SCORAD and the Eczema Area and Severity Index [EASI])."

Funding for the study was provided through grants from the Northwestern University Skin Disease Research Center, the Northwestern University Clinical and Translational Sciences Institute, Regeneron, and Sanofi. Guttman-Yassky and a second author report receiving grants from Regeneron during the conduct of this study. The remaining authors and Castelo-Soccio report no relevant financial relationships.

JAMA Dermatol. Published online October 9, 2019. Abstract, Editorial

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