**4. Abbreviations**

184 Atopic Dermatitis – Disease Etiology and Clinical Management

the association of FLC levels with age or total IgE levels was not confirmed (Kayserova et al., 2010).Vitamin D deficiency may be related to the severity of AD in the children patients. The level of serum in severe AD was significant lower than the mild AD (Peroni et al., 2010).

Leukotriene B4 (LTB4), LTC4, LTD4 and LTE4, the products of the oxidative metabolism of cell membrane arachidonic acid are secreted from eosinophils, mast cells and other inflammatory cells. As LTE4 is stable in urine, the urinal level of LTE4 may be a good marker for activation of mast cells and eosinophils in vivo. Urinary LTE4 increased in severe AD and correlated with severity of AD in children had been confirmed. Those having to sensitization to common allergens had higher LTE4 level than those without in the severe

EDN/EPX, one of the major proinflammatory mediators released by activated eosinophils, can induce severe tissue damage and maintenance and exacerbation of AD. A positive correlation between the SCORAD and serum ECP and urine EPX levels has been reported in children and adult patients (Breuer et al., 2001; Pucci et al., 2005; Pucci et al., 2000; Goto et al., 2007),also correlated with visual analog scales (VAS) scores for itching(Goto et al., 2007). While urinary EDN concentrations did not correlate with the number of eosinophils in the

Urinary nitrate level significantly increased in AD patients. The severity and extent of AD significantly correlated with urinary nitrate and malondialdehyde level, but it did not correlate with urinary 8-hydroxydeoxyguanosine (8-OHdG) level (Nakai et al., 2009). The increased TEWL in AD is attributable partly to impaired barrier function of the skin. Remarkable loss of body fluid would induce a series of systemic regulatory reactions. The functional antidiuretic hormone (ADH)–aquaporin (AQP)-2 axis is a major regulatory system to keep water balance. Increased serum ADH was detected in severe AD, a result possibly due to a dehydrated state caused by increased TEWL in these patients (Aoki, 2005). Recently, Urinary aquaporin-2 was found to be increased in infant AD patients, and positively correlate with skin dryness of infant AD, but its concentrations did not correlate with the number of eosinophils in the peripheral blood and the total IgE level in serum and

Increased neopterin levels in serum or urine are connected with diseases related with cellular immune reaction (Murr et al., 2002).In the association study by Horak E et al between neopterin in cord blood and urine in early childhood and the development of atopic dermatitisAD, they showed that family history of atopic disease was associated with

Prostaglandin D2 (PGD2), the major cyclooxygenase product of mast cells, is a good marker for mast cell activation. In the lung, PGD2 converts to 9a, 11b-prostaglandin F2 (9a,11b-PGF2), which can be detected in the urine (O'Sullivan, 1999). The study of Oymar K and Aksnes L indicated that 9a, 11b-PGF2 level in the urine of severe childhood AD patients was increased and indicated that 9a, 11b-PGF2 may be a useful biomarker of mast cell activation

AD is a complex cutaneous disorder characterized by local and/or systemic immune reactions, and skin barrier dysfunction. Its clinical manifestations are affected by many

lower urinary neopterin levels at age of 6 years (Horak er al., 2006).

**2.3.3 Biomarkers in urine** 

AD (Hon et al., 2004; Oymar &Aksnes, 2005).

peripheral blood (Goto et al., 2007).

disease severity (Di et al., 2010).

in the urine (Oymar &Aksnes, 2004).

**3. Conclusions** 

Atopic dermatitis (AD); Hanifin and Rajka diagnostic criteria (H-R criteria); International Study of Asthma and Allergies in Childhood (ISAAC); Quality of life (QoL); Scoring Atopic Dermatitis index (SCORAD); Dermatitis Area and Severity Index score (ADASIS); Eczema Area and Severity Index (EASI); Psoriasis area and severity index (PASI); Nottingham Eczema Severity Score (NESS); Children's Dermatology Life Quality Index (CDLQI); Objective severity assessment of atopic dermatitis (OSAAD system); Stratum corneum hydration (SCH); Trans-epidermal water loss (TEWL); Body surface area (BSA); Stratum corneum (SC); Natural moisturizing factors (NMF); Pyrrolidone carboxylic acid (PCA); Urocanic acid (UCA); Atopy patch test (APT); Skin prick test (SPT); Eosinophil cationic protein (ECP); Eosinophil derived neurotoxin/eosinophil protein X (EDN/EPX); T-regulatory (Treg); Interleukin (IL); CCL2/MCP-1, monocyte chemotactic protein 1; CCL11 /eotaxin (EOX); CCL17 /TARC, thymus and activation-regulated chemokine; CCL22 /MDC, macrophage-derived chemokine; CCL26 /eotaxin-3; CCL27/CTACK, cutaneous T cell–attracting chemokine; CCL28/ MEC, Mucosa-associated epithelial chemokine; CXCL10 /IP-10, IFN-induced protein of 10 kd; CX3CL1 /fractalkine; sE-selectin, serum soluble E-selectin ; sIL-2R, soluble interleukin-2 receptor . Tumor necrosis factor (TNF); B cell-activating factor (BAFF); Neurotrophins (NT); Nerve growth factor (NGF);

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