Exploring the link between atopic dermatitis and lipid profiles in children: A cross-sectional analysis

Authors

Abstract

AimAtopic dermatitis is a chronic inflammatory skin disorder with multifactorial pathophysiology, including immune dysregulation, epidermal defects, and environmental triggers. Recent studies suggest an association between AD and dyslipidemia, driven by systemic inflammation, but this link remains unclear in pediatric populations.
Materials and MethodsA total of 52 children with AD and 55 healthy controls aged 6–17 were analyzed. Lipid profiles, including total cholesterol, high-density- lipoprotein cholesterol, low-density-lipoprotein cholesterol, and triglycerides, were compared between groups. Disease severity was assessed using SCORAD. Statistical analyses included t-tests, ANOVA, and chi-square tests.
Results No significant differences in BMI, age, or socioeconomic factors were observed between groups. AD patients showed slightly higher total cholesterol (4.22 vs. 3.99 mmol/L, p=0.057) and low-density-lipoprotein cholesterol (2.47 vs. 2.28 mmol/L, p=0.097) compared to controls, without reaching statistical significance. Triglyceride and high-density-lipoprotein cholesterol levels were comparable. Lipid levels did not correlate significantly with AD severity.
Discussion While trends suggest higher lipid levels in children with AD, no significant associations were identified. Variations across global studies highlight methodological and demographic differences.

Keywords

Introduction

Atopic dermatitis (AD) is a chronic relapsing and remitting inflammatory dermatosis. It is the most prevalent skin disorder among children. Childhood-onset AD begins early in life, with 50% diagnosed in the first year of life and 85% by 5 years of age [1]. The pathophysiology of AD is complex, and there is increasing recognition of the heterogeneous nature of AD. [2]. The development is influenced by a complex of immune dysregulation, epidermal gene mutations, and environmental factors that disrupt the epidermis, causing scaly, erythematous, and intensely pruritic skin lesions. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which has a significant impact on the patient’s quality of life [3, 4].
In 2022, the World Health Organization (WHO) released a report stating that 60% of adult Europeans and 1 in 3 children are obese or overweight [5]. Epidemiological studies have found that adult eczema may be associated with higher odds of obesity, hypertension, and high cholesterol levels [6]. To understand the possibility of this link, we need to ‘dive deeper’: in obesity, hypertrophic adipocytes secrete high levels of pro-inflammatory adipokines and free fatty acids, leading to inflammation and dyslipidemia [7]. Furthermore, elevated triglycerides and low-density lipoprotein cholesterol lead to increased pro-inflammatory signaling and increased expression of TNF-α and interleukin (IL)-6. This supports the interpretation that the presence of chronic inflammatory state is responsible for chronic skin inflammation, therefore, it provides a possible mechanism for the relationship between atopic dermatitis and hyperlipidemia [8, 9].
The association between AD and dyslipidemia in children is still unclear.

Materials and Methods

Data Source and Participants
Analysis included 52 patients with atopic dermatitis (27 boys and 25 girls) and 55 healthy controls (19 boys and 30 girls); all of them were 6-17 years old. The group of AD patients was split into three groups based on their SCORing Atopic Dermatitis (SCORAD) index results (<25 mild, 25-50 moderate, >50 severe AD): severe AD group contained 19 patients, moderate 20 and mild 13 patients.
Measurements
Sociodemographic information, including age, sex, and severity of atopic dermatitis, was obtained via face-to-face interviews. Body weight and height were measured by nurses, and Body Mass Index (BMI) was then calculated. The subjects’ BMI values were not statistically significantly different and were within the normal range according to the WHO guidelines. The mean BMI was 19.58±4.76 in the AD group and 18.01±3.36 in the control group. There were no differences in age, gender, weight, and height between the groups.
Blood collection procedures were done by nurses according to the blood drawing protocol. Serum lipids were measured, and it included Total Cholesterol (TCh), High-density-lipoprotein cholesterol (HDL Ch), Low-density-lipoprotein cholesterol (LDL Ch), and Triglycerides (Tg).
Statistical Analysis
Statistical analyses were conducted using SPSS software, version 29.0.2.0 (IBM Corp., Armonk, NY, USA). Comparative analyses of lipid panel parameters (TCh, LDL, HDL cholesterol, and Tg) and socioeconomic factors were performed between the AD and control groups. Within the AD group, the SCORAD index and severity of AD were analyzed. Independent Samples t-tests were used to compare continuous variables between the groups. Spearman’s Correlation Analysis was applied to evaluate relationships between the lipid panel parameters and other variables, including living area and income. Analysis of Variance (ANOVA) was employed to assess variations in TCh levels across different SCORAD severity groups. Chi-square tests were used to analyze the distribution of SCORAD severity, living area, and income prevalence.
Ethical Approval
This study was approved by the Vilnius Regional Biomedical Research Ethics Committee (Date: 2020-08-25, No: 2020/8- 1251-733).

Results

Participant Characteristics
The study included 52 patients with atopic dermatitis (AD) and 55 healthy controls (C). The groups were comparable in terms of sex distribution, with the AD group comprising 19 boys and 30 girls and the control group consisting of 27 boys and 25 girls. Three participants in the AD and C group had gender recorded as “N/A.” Age distribution did not differ significantly between the groups (p = 0.189). The general characteristics of the AD and C groups are shown in Table 1.
Anthropometric Data
The mean weight was slightly higher in the AD group compared to the control group (44.99±18.87 kg vs. 42.07±16.22 kg), although the difference was not statistically significant (p = 0.487). BMI was also higher in the AD group (mean 19.58±4.76 kg/m²) compared to the control group (mean 18.01±3.36 kg/ m²), but this difference did not approach significance (p = 0.097).
The confidence interval for the mean difference in BMI was -0.11 to 3.31, supporting the trend toward higher BMI in the AD group (Table 1).
Living Area and Socioeconomic Data
The distribution of living areas did not differ significantly between the groups (p = 0.317). Most of the participants in both groups lived in urban areas (63.3% in AD and 75.5% in control). Monthly income per person was categorized into six groups; no significant differences were observed between groups (p = 0.176).
Lipid Panel Results
Analysis of lipid profiles revealed the following key findings:
• Total cholesterol (TCh) was higher in the AD group (4.22±0.60 mmol/L) than in the control group (3.99±0.69 mmol/L), with a p-value of 0.057, suggesting a trend toward significance.
• LDL cholesterol was higher in the AD group (2.47±0.55 mmol/L) compared to the control group (2.28±0.62 mmol/L; p = 0.097).
• Triglycerides (Tg) and HDL cholesterol showed no statistically significant differences between groups (p = 0.104 and p = 0.972, respectively).
These findings highlight slight elevations in TCh and MTL Ch levels in the AD group compared to controls, though statistical significance was not reached (detailed information is provided in Table 2).
Association Between Lipid Panel and Disease Severity
The SCORAD index classified 13 participants as having mild AD, 20 as moderate, and 19 as severe. Total cholesterol levels were highest in the mild group (4.35±0.58 mmol/L) and lowest in the moderate group (4.17±0.59 mmol/L). LDL cholesterol was elevated in all groups, with the highest levels observed in the mild category. Triglycerides increased with severity, from 0.72±0.39 mmol/L in mild AD to 1.02±0.79 mmol/L in severe AD.

Discussion

In this study, we did not find any significant relationship between dyslipidemia, obesity, and severity of atopic dermatitis. Means of Total Cholesterol, LDL Cholesterol, and Triglycerides were higher in the AD group. These findings suggest that while there are observable trends in lipid panel differences between AD and C groups, none of the associations reached statistical significance in this sample.
We compared our study results with the findings of other studies. Agón-Banzo PJ et al. (2020, n=239) found that AD patients, especially those with severe AD, had higher serum lipid levels and BMI compared to healthy controls, with significant differences in total cholesterol and triglycerides [10]. Kim JH et al. (2021, n=52 973): In two subsets, children with AD had significantly higher levels of total cholesterol and triglycerides, with the SCORAD index also associated with these lipid abnormalities. Additionally, higher total cholesterol was linked to an increased risk of AD onset over five years [8]. Seong MK et al. (2023, n=1 617) used data from Korean adolescents and found that those with AD had significantly higher levels of total cholesterol and low-density lipoprotein cholesterol compared to those without AD. Dyslipidemia (LDL-Ch (Low-Density Lipoprotein Cholesterol) ≥130 mg/dL) was identified as a risk factor for AD, although high total cholesterol (≥200 mg/dL) was not. No significant relationship between obesity and AD prevalence was found, but dyslipidemia may be associated with AD development [11].
In contrast, a UK Biobank-based observational study done by Tang Z. et al. (2022) included a total of 502,505 participants and found that the association of triglycerides with AD was not significant and the effect on HDL exhibited a high inconsistency [12]. Standl M. et al. (2016) analysed three cohorts (a total of more than 1 million cases) and found that AD was not associated with cardiovascular risk factors and no differences in metabolite levels were detected (p=0.9846 for HDL cholesterol, p=0.6942 for Tg and for LDL p=0.3007) [13]. Leigh JH et al. (2021) enrolled 2,914 adolescents (12-18 y.o.) and performed two models for the study. Neither showed significant association between AD and hypercholesterolemia (p=0.343 for Model 1 and 0.287 for Model 2), low HDL (p= 0.456 and 0.408) or hypertriglyceridemia (p= 0.087 for Model 1 and p=0.106 for Model 2) [14].
The inconsistency might be explained by the difference in study design, the diagnostic criteria of AD and dyslipidemia, regional differences, and by the varied definitions of overweight and obesity used in the studies. Also, while socioeconomic factors were considered, other confounders (e.g., diet, physical activity, or genetic predispositions) were not controlled for.
The major strength of this study is that all of the data were collected by the same person, and all of the blood work was performed in the same laboratory. This way, the misclassification or different interpretations of the results were avoided, and we were working with well-defined groups. However, our sample size for either group was small, which limits the statistical power to detect significant differences. Also, relying heavily on p-values might overlook clinically significant trends that are not statistically significant (e.g., borderline results for lipid levels).

Limitations

This study is limited by its relatively small sample size, which may reduce statistical power and the ability to detect significant differences between groups. Additionally, the cross- sectional design prevents conclusions about causality between atopic dermatitis and lipid profile alterations. Finally, the study population was region-specific, potentially limiting the generalizability of findings to broader pediatric populations.

Conclusion

While trends toward dyslipidemia were observed in pediatric AD patients, no definitive association was identified. Future research should focus on larger, multicenter cohorts with robust control of confounders to elucidate the relationship between AD and lipid abnormalities in children.

References

1. Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: Diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91-101.
   PubMed Google Scholar
2. Malik K, Heitmiller KD, Czarnowicki T. An update on the pathophysiology of atopic dermatitis. Dermatol Clin. 2017;35(3):317-26.
   PubMed Google Scholar
3. Frazier W, Bhardwaj N. Atopic dermatitis: Diagnosis and treatment. Am Fam Physician. 2020;101(10):590-8.
   PubMed Google Scholar
4. Sid Idris F. Treatment of atopic dermatitis in children. Cureus. 2024;16(9):e69416
   PubMed Google Scholar
5. Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: As its twin, the COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;133:155217.
   PubMed Google Scholar
6. Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):721-8.e6.
   PubMed Google Scholar
7. Trandafir LM, Dodi G, Frasinariu O, et al. Tackling dyslipidemia in obesity from a nanotechnology perspective. Nutrients. 2022;14(18):3774.
   PubMed Google Scholar
8. Kim JH, Lee SW, Yon DK, et al. Association of serum lipid parameters with the SCORAD index and onset of atopic dermatitis in children. Pediatr Allergy Immunol. 2021;32(2):322-30.
   PubMed Google Scholar
9. Manti S, Leonardi S, Panasiti I, Arrigo T, Salpietro C, Cuppari C. Serum IL-10, IL-17 and IL-23 levels as “bioumoral bridges” between dyslipidemia and atopy. Cytokine. 2017;99:43-9.
   PubMed Google Scholar
10. Agón-Banzo PJ, Sanmartin R, García-Malinis AJ, et al. Body mass index and serum lipid profile: association with atopic dermatitis in a paediatric population. Australas J Dermatol. 2020;61(1):e60-4.
    PubMed Google Scholar
11. Seong MK, Shin M. Low-density lipoprotein cholesterol is associated with atopic dermatitis in Korean adolescents. Int Arch Allergy Immunol. 2023;184(12):1230-6.
    PubMed Google Scholar
12. Tang Z, Shen M, Xiao Y, Liu H, Chen X. Association between atopic dermatitis, asthma, and serum lipids: A UK Biobank-based observational study and Mendelian randomization analysis. Front Med (Lausanne). 2022;9:810092.
    PubMed Google Scholar
13. Standl M, Tesch F, Baurecht H, et al. Association of atopic dermatitis with cardiovascular risk factors and diseases. J Invest Dermatol. 2017;137(5):1074- 81.
    PubMed Google Scholar
14. Leigh JH, Park HJ, Chun SM, Min YS, Choi M. Association of atopic dermatitis with dyslipidemia in adolescents: A cross-sectional study. Ann Dermatol. 2021;33(5):483-5.
    PubMed Google Scholar

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