The molecular features of normal and atopic dermatitis skin in infants, children, adolescents, and adults

J Allergy Clin Immunol. 2021 Jul;148(1):148-163. doi: 10.1016/j.jaci.2021.01.001. Epub 2021 Jan 13.


Background: Although atopic dermatitis (AD) often presents in infancy and persists into adulthood, comparative characterization of AD skin among different pediatric age groups is lacking.

Objective: We sought to define skin biopsy profiles of lesional and nonlesional AD across different age groups (0-5-year-old infants with disease duration <6 months, 6-11-year-old children, 12-17-year-old adolescents, ≥18-year-old adults) versus age-appropriate controls.

Methods: We performed gene expression analyses by RNA-sequencing and real-time PCR (RT-PCR) and protein expression analysis using immunohistochemistry.

Results: TH2/TH22 skewing, including IL-13, CCL17/thymus and activation-regulated chemokine, IL-22, and S100As, characterized the common AD signature, with a global pathway-level enrichment across all ages. Nevertheless, specific cytokines varied widely. For example, IL-33, IL-1RL1/IL-33R, and IL-9, often associated with early atopic sensitization, showed greatest upregulations in infants. TH17 inflammation presented a 2-peak curve, with highest increases in infants (including IL-17A and IL-17F), followed by adults. TH1 polarization was uniquely detected in adults, even when compared with adolescents, with significant upregulation in adults of IFN-γ and CXCL9/CXCL10/CXCL11. Although all AD age groups had barrier abnormalities, only adults had significant decreases in filaggrin expression. Despite the short duration of the disease, infant AD presented robust downregulations of multiple barrier-related genes in both lesional and nonlesional skin. Clinical severity scores significantly correlated with TH2/TH22-related markers in all pediatric age groups.

Conclusions: The shared signature of AD across ages is TH2/TH22-skewed, yet differential expression of specific TH2/TH22-related genes, other TH pathways, and barrier-related genes portray heterogenetic, age-specific molecular fingerprints.

Keywords: Atopic dermatitis; T(H)2; T(H)22; biomarkers; epidermal barrier; maturation; normal skin; pediatric.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers / metabolism
  • Child
  • Cytokines / immunology
  • Dermatitis, Atopic / immunology*
  • Dermatitis, Atopic / metabolism
  • Eczema / immunology
  • Eczema / metabolism
  • Female
  • Filaggrin Proteins
  • Humans
  • Infant
  • Inflammation / immunology
  • Inflammation / metabolism
  • Male
  • Severity of Illness Index
  • Skin / immunology*
  • Skin / metabolism
  • Th2 Cells / immunology
  • Th2 Cells / metabolism
  • Young Adult


  • Biomarkers
  • Cytokines
  • FLG protein, human
  • Filaggrin Proteins