Evaluation of neutrophil-to-lymphocyte, platelet-to-lymphocyte and eosinophil-to-lymphocyte ratios in childhood atopic dermatitis: Association with disease severity and treatment response

Objective: Atopic dermatitis (AD) is a common chronic, inflammatory skin disease in childhood, characterized by pruritus and recurrent exacerbations. AD may impair daily functioning and negatively affect quality of life, psychosocial status, and personal development. In recent years, hematologic inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and eosinophil-to-lymphocyte ratio (ELR) have been investigated as potential biomarkers in chronic inflammatory diseases. The aim of this study was to evaluate the relationship between disease severity assessed by the Eczema Area and Severity Index (EASI) and inflammatory biomarkers (NLR, PLR, and ELR), and to determine whether these markers can predict prognosis and treatment response in children with AD. Materials and Methods: This prospective observational study included pediatric patients diagnosed with AD based on standard diagnostic criteria. Demographic characteristics, clinical findings, laboratory parameters, and quality of life scores (Infants’ Dermatitis Life Quality Index, IDLQI) were recorded. EASI scores were calculated at diagnosis and after treatment. Receiver operating characteristic (ROC) analyses were performed to determine whether hematologic inflammatory parameters predicted ≥50% improvement in EASI score. Results: Seventy patients without additional chronic disease were included; 41 (58.6%) were boys. The mean age was 9.4 ±14.4 months. ROC analysis demonstrated that the neutrophil-to-lymphocyte ratio (NLR) significantly differentiated patients who achieved ≥50% reduction in EASI score from those who did not (AUC = 0.648, p =0.041; 95% CI: 0.50–0.70). The optimal cutoff value for NLR was 0.3. Conclusion: NLR is a rapid, inexpensive, and widely accessible biomarker that may help predict disease prognosis and treatment response in pediatric AD. Incorporating NLR into routine follow-up may assist clinicians in monitoring inflammation and optimizing treatment strategies.