Pathobiology of atopic dermatitis and association with disease severity after acute oral steroid treatment

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with complex immune dysregulation. Acute oral corticosteroids relieve measures of AD severity during flares; however, the association of disease severity with anti-inflammatory effects in skin remains unclear. Objective: We sought to evaluate the association between clinical severity and skin inflammation in AD. Methods: Sixteen patients with moderate to severe AD were randomized 1:1 to prednisolone (0.75-0.25 mg/kg tapered over 15 days) or placebo following an 8-day run-in without systemic anti-inflammatory medications. Clinical scores were measured and biopsies from lesional and allergen-challenged skin were collected and analyzed by histology, immunofluorescence microscopy, and ELISA for cells and cytokine levels. Results: < .05) in both allergen-challenged and lesional skin. Conclusions: Prednisolone modulated a broad range of inflammatory pathways in acute versus chronically inflamed AD skin. Furthermore, identification of positive associations between inflammation and clinical outcomes supports the development of therapeutics beyond type 2 inflammation.