Association of SCORAD Values with Skin Barrier Function Indicators in Patients with Atopic Dermatitis

Presenter: S. Seo

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by recurrent flares and impaired skin barrier function. Disease severity is routinely evaluated using the Scoring Atopic Dermatitis (SCORAD) index; however, this clinical tool may not fully reflect dynamic, day-to-day changes in skin barrier integrity. Objective measures like transepidermal water loss (TEWL) and skin hydration (epidermal and dermal) are markers of barrier disruption, yet their correspondence with SCORAD-based severity categories remains incompletely defined.  This study evaluated the relationship between clinical disease severity and objective skin barrier measurements in adults with atopic dermatitis (AD). The investigators assessed whether transepidermal water loss (TEWL) and skin hydration measurements corresponded with disease severity measured by the Scoring Atopic Dermatitis (SCORAD) index. Ten adults with AD (mean age 32.7 years) underwent daily SCORAD assessments along with measurements of TEWL, epidermal hydration, and dermal hydration using a wearable skin monitoring device. Participants were categorized as having mild (SCORAD <25), moderate (25–50), or severe (>50) disease. Associations were assessed using Pearson and Spearman correlations, and group differences using one-way ANOVA or Kruskal–Wallis tests with Bonferroni-adjusted Mann–Whitney U post hoc analyses; findings were visualized using scatter and standardized (z-score) time-series plots. Higher SCORAD scores were associated with greater skin barrier dysfunction. Patients with more severe AD had higher TEWL values, indicating increased water loss through the skin, and lower epidermal and dermal hydration levels compared with those with mild or moderate disease. Correlation analyses showed that SCORAD was positively associated with TEWL and negatively associated with skin hydration. In addition, TEWL demonstrated a strong inverse relationship with hydration levels, suggesting that worsening skin barrier function was accompanied by reduced skin moisture. Time-series analyses revealed considerable variation between individuals. In some cases, physiological changes in skin barrier function occurred even when SCORAD scores remained relatively stable, indicating that objective skin measurements may capture changes not reflected by clinical severity scores alone.

Overall, objective measures of skin barrier function, including TEWL and skin hydration, were closely associated with AD severity and may provide additional information for monitoring disease activity alongside SCORAD.

Natural History of Early Onset Atopic Dermatitis and Risk Factors for Persistency Using Korean National Health Service Data

Presenter: M. Kim

The long-term course of early-onset atopic dermatitis (AD), particularly its persistence into adolescence and its association with comorbid atopic diseases, remains poorly characterized. This nationwide population-based study evaluated the long-term course of early-onset atopic dermatitis (AD) and identified factors associated with disease persistence. Data were obtained from the Korean National Health Insurance Service database and included children diagnosed with AD (International Classification of Diseases, 10th Revision [ICD-10] code L20) as a primary diagnosis on at least two occasions before 2 years of age between 2008 and 2017. Children with congenital diseases or chromosomal abnormalities were excluded. Participants were followed until 2022, and disease persistence was assessed based on annual AD-related healthcare visits. Risk factors were evaluated using the Cox proportional hazards models. A total of 1,295,787 children were included in the analysis. The findings showed that the majority of children with early-onset AD experienced remission over time. Only 13.8% of children continued to receive AD-related care at 5 years of age, which further declined to 9.0% at 10 years and 1.2% at 14 years. Several factors were independently associated with persistent AD. These included female sex, diagnosis before 2010, older age at initial diagnosis, lower socioeconomic status, and living in Seoul. In addition, children with comorbid food allergy or asthma had a higher likelihood of persistent disease.

Overall, the study demonstrated that most cases of early-onset AD resolved before adolescence. However, demographic characteristics, socioeconomic factors, and the presence of allergic comorbidities were associated with an increased risk of disease persistence.

Are Maternal Epidermal Lipid Profiles Associated with Atopic Dermatitis Development in Early Childhood?

Presenter: J. Kim

Early-life epidermal barrier dysfunction plays a central role in the pathogenesis of atopic dermatitis (AD). However, despite extensive research on infant skin lipids, the association between maternal stratum corneum (SC) lipid profiles in early infancy and the subsequent risk of AD in offspring remains unclear. This birth cohort study investigated whether maternal stratum corneum (SC) ceramide composition in early infancy is associated with the future development of atopic dermatitis (AD) in children. The study included 106 mother–child pairs, with children followed prospectively until 3 years of age. Stratum corneum (SC) samples were collected from the forearm of both mothers and infants at 2 months postpartum using skin tape stripping. Lipidomic profiles were analyzed using liquid chromatography–electrospray ionization tandem mass spectrometry. By 3 years of age, 34 children had developed AD and 72 had not, based on physician diagnosis. Mothers of children who later developed AD showed significantly higher levels of several ultra–long-chain esterified ω-hydroxy ceramides (EOS-CER), particularly EO30–EO34 species containing C18, C20, and C22 sphingoid bases (P<0.05). Total maternal EOS-CER levels were significantly higher in mothers of children who developed AD compared with mothers of children who did not develop AD (median: 1205.2 vs 971.9; P=0.039). In addition, maternal ceramide subclass ratios reflecting the balance between non-hydroxy fatty acid–sphingosine ceramides (NS-CER) and non-hydroxy fatty acid–phytosphingosine ceramides (NP-CER), including C20S/C20P and C22S/C22P, were significantly elevated in the AD group (P<0.05). Mothers of children who developed AD also had higher ratios of EOS-CER to the corresponding protein-bound ceramides. Correlation analyses showed generally positive relationships between maternal and infant SC ceramide profiles, particularly for EOS-CER, NS-CER, and NP-CER subclasses.

Overall, maternal SC ceramide composition at 2 months postpartum was associated with the later development of AD in children up to 3 years of age, suggesting a relationship between maternal skin barrier lipid characteristics and childhood AD risk.

Clinical and Immunological Phenotypes of Alopecia Areata in Children with Atopic Dermatitis

Presenter: R. Khanferyan

Alopecia areata (AA) and atopic dermatitis (AD) are chronic immune-mediated diseases that commonly coexist in children. This study aimed to characterize the clinical and immune phenotypes of pediatric AA associated with AD using cluster analysis. This single-center, cross-sectional study explored the clinical and immune phenotypes of alopecia areata (AA) in children with concomitant atopic dermatitis (AD). The study included 68 children aged 5–16 years with both AA and AD. Disease severity was assessed using the Severity of Alopecia Tool (SALT) for AA and the Scoring Atopic Dermatitis (SCORAD) index for AD. Additional evaluations included age at AA onset, quality of life using the Children’s Dermatology Life Quality Index (CDLQI), atopic comorbidities, and serum immunoglobulin E (IgE) levels measured by enzyme-linked immunosorbent assay (ELISA). Spearman’s correlation and k-means clustering (variables: SALT, SCORAD, IgE, age of AA onset) were used. Spearman’s correlation analysis demonstrated a moderate positive correlation between AA severity (SALT) and AD severity (SCORAD) (ρ = 0.512, p < 0.001). Both SALT and SCORAD were moderately correlated with poorer quality of life (CDLQI; ρ = +0.532 and +0.469, respectively; p < 0.001), while SALT showed a moderate negative correlation with age at AA onset (ρ = –0.418, p = 0.001), indicating more severe hair loss with earlier disease onset. Serum IgE levels correlated positively with both disease severity measures. Cluster analysis identified three distinct clinical phenotypes, suggesting two potential pathways to severe alopecia: one associated with very early disease onset and the other with a high systemic Th2-driven atopic burden.

Overall, the study highlights the heterogeneity of pediatric AA in children with AD and suggests that factors such as age at disease onset, disease severity, and atopic burden may help identify children at higher risk of severe disease and impaired quality of life.

Early-Life Dietary Diversity and the Risk of Atopic Dermatitis: A Nationwide Population-Based Cohort Study

Presenter: JH. Kim

Early dietary antigen exposure via the gut mucosa during infancy is essential for the development of immune tolerance and may modulate the risk of allergic diseases. However, evidence linking dietary diversity during infancy with the subsequent development of atopic dermatitis (AD) is limited. This nationwide population-based cohort study evaluated whether dietary diversity during infancy is associated with the subsequent risk of developing atopic dermatitis (AD). The analysis used data from the Korean National Health Insurance Service and included children born in Korea between 2009 and 2010 who participated in the National Health Screening Program for Infants and Children at approximately 1 year of age. Dietary exposure was assessed using a parental questionnaire that recorded the intake of six complementary food groups. Children were categorized according to the number of food groups consumed: 1–2, 3–4, or 5–6 food groups. Children with a diagnosis of AD before dietary assessment were excluded. Participants were followed from the time of questionnaire completion until 2023, and incident cases of AD were identified using insurance claims data. A total of 267,935 children were included in the analysis. Cox proportional hazards models was used to assess the risk of atopic dermatitis. The mean age at dietary assessment was 0.94 years, and 50.7% were male. Among the participants, 7.6% consumed 1–2 food groups, 35.5% consumed 3–4 food groups, and 56.8% consumed 5–6 food groups. The incidence rates of AD per 10,000 person-years were lowest among children exposed to 5–6 food groups (109.9), compared with those exposed to 3–4 food groups (122.7) and 1–2 food groups (120.6). Compared with children who consumed 5–6 food groups, the risk of developing AD was significantly higher among those exposed to fewer food groups. Children consuming 3–4 food groups had an 11% higher risk of AD (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.09–1.13), while those consuming 1–2 food groups had an 8% higher risk (HR 1.08; 95% CI 1.04–1.12).

Overall, lower dietary diversity before 1 year of age was associated with an increased risk of developing AD, suggesting that exposure to a wider variety of complementary foods during infancy may be linked to a lower risk of the disease.

Atopic Dermatitis Increases the Risk of Chronic Systemic Diseases in Children and Adolescents: A Nationwide Nested Case–Control Study

Presenter: S. Shin

Atopic dermatitis (AD) is a common chronic inflammatory skin disease in childhood that affects up to 20% of children worldwide. Beyond its cutaneous manifestations, AD has been associated with multiple comorbidities, suggesting a potential role of early-life AD in the development of chronic systemic diseases. This nationwide nested case-control study investigated whether atopic dermatitis (AD) is associated with an increased risk of chronic systemic diseases in children and adolescents. The analysis used data from the Korean Health Insurance Review and Assessment Service and included individuals born in 2002 who were followed from January 2002 to December 2020. Cases were defined as individuals diagnosed with chronic systemic diseases based on International Classification of Diseases, 10th Revision (ICD-10) codes. Each case was matched with five controls according to sex and income level. AD was identified using ICD-10 codes, and severe AD was defined as disease requiring systemic treatment or hospitalization. Among 495,039 individuals in the birth cohort, 13,600 cases of chronic systemic diseases were identified. Associations were evaluated using conditional logistic regression, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Children and adolescents with AD had a significantly higher risk of developing chronic systemic diseases compared with those without AD. The increased risk was observed across multiple conditions, including autoimmune diseases, metabolic and cardiovascular diseases, eosinophilic esophagitis, inflammatory bowel disease, nephritic syndrome, and diabetes mellitus. Overall, AD was associated with an 18.1% increased risk of chronic systemic diseases (odds ratio [OR] 1.181; 95% confidence interval [CI] 1.137–1.228). A severity-dependent association was also observed. Compared with individuals without AD, those with severe AD had a higher risk of chronic systemic diseases (OR 1.218; 95% CI 1.146–1.294) than those with mild-to-moderate AD (OR 1.164; 95% CI 1.108–1.222).

These findings indicate that AD, particularly severe AD, is associated with an increased risk of a broad range of chronic systemic diseases in children and adolescents, supporting the concept of paediatric AD as a systemic inflammatory disorder.

Atypical Chronic Cheilitis as Manifestation of Atopic Dermatitis: A Diagnostic Dilemma

Presenter: I. Caraman

Chronic cheilitis is a common manifestation of atopic dermatitis (AD), typically presenting as eczematous inflammation with erythema and scaling. Rarely, it may present as persistent, localized, non-pitting lip edema with a granulomatous-like appearance. The presence of a fissured tongue, an under-recognized feature in atopic patients, may further complicate diagnosis. This presentation closely mimicks granulomatous cheilitis of Miescher and poses diagnostic challenge. 

This case report describes an unusual presentation of atopic cheilitis in a 19-year-old male with an atopic background. Unlike the typical eczematous features of atopic cheilitis, the patient presented with persistent, non-pruritic, non-pitting swelling of the central upper lip and a fissured tongue, Symptoms began in June 2025 following significant emotional stress. The condition initially presented as exfoliative cheilitis and subsequently progressed to persistent lip swelling. Treatment with the high-potency topical corticosteroid clobetasol propionate was ineffective, while topical tacrolimus 0.1% resulted in only partial improvement. Physical examination revealed minor features associated with atopic dermatitis, including xerosis, keratosis pilaris, nummular eczema on the forearm, and retro-auricular hyperlinearity. Although the patient did not meet the major diagnostic criteria for atopic dermatitis (AD), laboratory testing showed elevated total immunoglobulin E (IgE) levels, supporting an atopic predisposition. To exclude other causes, extensive investigations were performed. Patch testing using the European Baseline Series was negative for allergic contact dermatitis. Additional laboratory assessments, including serum iron, vitamin B12, antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA) antibodies, and infectious disease screening, were unremarkable. Because of the persistent lip edema and fissured tongue, granulomatous cheilitis was strongly suspected, and a biopsy was performed. Histopathological examination showed a non-specific chronic inflammatory infiltrate without non-caseating granulomas, ruling out granulomatous cheilitis and supporting an eczematous process. Based on the clinical, laboratory, and histopathological findings, the patient was diagnosed with an atypical granulomatous-like (“pseudogranulomatous”) form of atopic cheilitis. 

Atopic dermatitis (AD) may present with atypical cheilitis phenotypes beyond classic eczematous changes. Chronic inflammation can result in persistent localized lip edema that mimics Miescher’s cheilitis, while a fissured tongue may represent an overlooked feature of atopy. Histopathological evaluation is essential to exclude granulomatous cheilitis and other inflammatory disorders, enabling accurate diagnosis and appropriate management of the underlying atopic disease.

EAACI 2026, June 12-15, Istanbul, Türkiye