Intrinsic atopic dermatitis shows similar TH2 and higher T H17 immune activation compared with extrinsic atopic dermatitis

Mayte Suárez-Fariñas, Nikhil Dhingra, Julia Gittler, Avner Shemer, Irma Cardinale, Cristina De Guzman Strong, James G. Krueger, Emma Guttman-Yassky

Research output: Contribution to journalArticlepeer-review

350 Scopus citations


Background: Atopic dermatitis (AD) is classified as extrinsic and intrinsic, representing approximately 80% and 20% of patients with the disease, respectively. Although sharing a similar clinical phenotype, only extrinsic AD is characterized by high serum IgE levels. Because most patients with AD exhibit high IgE levels, an "allergic"/IgE-mediated disease pathogenesis was hypothesized. However, current models associate AD with T-cell activation, particularly TH2/TH22 polarization, and epidermal barrier defects. Objective: We sought to define whether both variants share a common pathogenesis. Methods: We stratified 51 patients with severe AD into extrinsic AD (n = 42) and intrinsic AD (n = 9) groups (with similar mean disease activity/SCORAD scores) and analyzed the molecular and cellular skin pathology of lesional and nonlesional intrinsic AD and extrinsic AD by using gene expression (real-time PCR) and immunohistochemistry. Results: A significant correlation between IgE levels and SCORAD scores (r = 0.76, P < 10 -5) was found only in patients with extrinsic AD. Marked infiltrates of T cells and dendritic cells and corresponding epidermal alterations (keratin 16, Mki67, and S100A7/A8/A9) defined lesional skin of patients with both variants. However, higher activation of all inflammatory axes (including T H2) was detected in patients with intrinsic AD, particularly T H17 and TH22 cytokines. Positive correlations between TH17-related molecules and SCORAD scores were only found in patients with intrinsic AD, whereas only patients with extrinsic AD showed positive correlations between SCORAD scores and TH2 cytokine (IL-4 and IL-5) levels and negative correlations with differentiation products (loricrin and periplakin). Conclusions: Although differences in TH17 and T H22 activation exist between patients with intrinsic AD and those with extrinsic AD, we identified common disease-defining features of T-cell activation, production of polarized cytokines, and keratinocyte responses to immune products. Our data indicate that a TH2 bias is not the sole cause of high IgE levels in patients with extrinsic AD, with important implications for similar therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)361-370
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - Aug 2013


  • Atopic dermatitis
  • IgE
  • S100 proteins
  • T cell
  • eczema
  • extrinsic
  • human skin
  • intrinsic
  • keratinocytes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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