The Imprint of Exposome on the Development of Atopic Dermatitis across the Lifespan: A Narrative Review

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects more than 200 million people worldwide, including up to 20% of children and 10% of the adult population. Although AD appears frequently in childhood and often continues into adulthood, about 1 in 4 adults develop the adult-onset disease. The prenatal period, early childhood, and adolescence are considered critical timepoints for the development of AD when the exposome results in long-lasting effects on the immune system. The exposome can be defined as the measure of all the exposures of an individual during their lifetime and how these exposures relate to well-being. While genetic factors could partially explain AD onset, multiple external environmental exposures (external exposome) in early life are implicated and are equally important for understanding AD manifestation. In this review, we describe the conceptual framework of the exposome and its relevance to AD from conception and across the lifespan. Through a spatiotemporal lens that focuses on the multi-level phenotyping of the environment, we highlight a framework that embraces the dynamic complex nature of exposome and recognizes the influence of additive and interactive environmental exposures. Moreover, we highlight the need to understand the developmental origins of AD from an age-related perspective when studying the effects of the exposome on AD, shifting the research paradigm away from the per se categorized exposome factors and beyond clinical contexts to explore the trajectory of age-related exposome risks and hence future preventive interventions.

Nurturing Infants to Prevent Atopic Dermatitis and Food Allergies: A Longitudinal Study

“…This intriguing finding prompts us to consider the role of environmental factors in AD development [ 38 ]. Previous studies have proposed that the presence of a garden may introduce infants to a wider range of allergens which could influence their immune system’s response and increase the AD risk [ 39 , 40 ]. Additionally, the use of chemicals in the garden, such as insecticides and pesticides, as suggested by Buralli et al in their review [ 41 ], could contribute to this phenomenon.…”

How to Understand Personalized Medicine in Atopic Dermatitis Nowadays?

“…The exposome is defined as the measure of all the exposures that an individual has had during their lifetime and how these exposures relate to the individual's well-being. Perfluoroalkyl and polyfluoroalkyl substances (PFASs), pollution, and maternal nutrition have been shown to be the most important exposomal factors in infancy and childhood [8]. Later on in adolescence, climate, infection, and rural and urban environments are the main players, while in adulthood, lifestyle factors and stress predominate [8].…”

“…Perfluoroalkyl and polyfluoroalkyl substances (PFASs), pollution, and maternal nutrition have been shown to be the most important exposomal factors in infancy and childhood [8]. Later on in adolescence, climate, infection, and rural and urban environments are the main players, while in adulthood, lifestyle factors and stress predominate [8]. The genetic and epigenetic signature (endotype) of each individual case leads to the development of complex molecular mechanisms.…”

The impact of glucocorticoids therapy on cutaneous wounds in Kawasaki disease: A meta‐analysis of randomized controlled trials

“…In KD, a diverse array of cutaneous manifestations contributes to the intricate clinical landscape of the disease 7 . Skin wounds characteristic of KD encompass an erythematous rash, desquamation and indurated edema 8 .…”