1. Background Type your answer / solution here Write hypothesis before you begin the experiment This should be your best educated guess based on your research The objectives of the study were : 1) To determine frequency and severity of hypoalbuminemia and hypoproteinemia in severe AD and its relationship with AD severity 2) To study effect of hypoalbuminemia and hypoproteinemia on the growth of these children. 1.Arkwright PD, Motala C, Subramanian H et al. Management of difficult-to- treat atopic dermatitis. J Allergy Clin Immunol Pract 2013; 1: 142-151. 2.Kelleher M, Dunn-Galvin A, Hourihane JO et al. Skin barrier dysfunction measured by transepidermal water loss at 2 days and 2 months predates and predicts atopic dermatitis at 1 year. J Allergy Clin Immunol 2015; 135: 930- 935. 3.Leung DY. New insights into atopic dermatitis: role of skin barrier and immune dysregulation. Allergol Int 2013; 62: 151-161. 4.Kim DW, Park JY, Na GY et al. Correlation of clinical features and skin barrier function in adolescent and adult patients with atopic dermatitis. Int J Dermatol 2006; 45: 698-701. Protein-Losing Dermopathy Impairing Growth in Children with Severe Atopic Dermatitis. Mohammad Ehlayel 1, 2, Ashraf Soliman 3 Protein-Losing Dermopathy Impairing Growth in Children with Severe Atopic Dermatitis. Mohammad Ehlayel 1, 2, Ashraf Soliman 3 Each patient record was also reviewed for demographic data, lab. tests including CBC with differential count, serum albumin, total globulins, IgG, IgA, IgM, IgG subclasses, total IgE, and serum zinc level. AD severity score (SCORAD) was collected. Anthropometric data ( age, weight and height) were collected. Body mass index (BMI) was calculated. Status of food allergy was reviewed as per food allergens tests (skin prick tests or PT or specific-IgE to a panel of 8 common food allergens including cow’s milk, egg, wheat, tree nuts, peanut, soy, fish and seafood). Hypothesis Objectives Patients and Methods Materials & Methods (contd.) Results Results (Cont.) Conclusions References 1) Weill-Cornell Medical College, 2) Section of Pediatric Allergy -Immunology, Hamad Medical Corporation, Doha, Qatar. 3) Section of Pediatric Endocrinology, Alexandria University, Alexandria, Egypt. Atopic dermatitis (AD) is a chronic, inflammatory skin disorder, affecting 15-20% of population. It is commoner in children than adults [1].1 Recent data indicate that structural abnormalities in the epidermis of AD results in a permeable skin barrier in the epithelial layer. This leads to trans- epidermal water loss (TEWL) and allergen/ microbial penetration into skin. Moderate-to-severe AD is seen in nearly 30% of cases [2, 3]. There is a significant correlation between AD clinical severity and skin barrier function, measured by TEWL[4]. Not only water is lost, but also including serum proteins and albumin.234 We hypothesize that protein-losing dermopathy, especially in severe cases, leads to impairment of growth among these children This retrospective study was performed on 135 records of all children (<14 years) seen at Ped Allergy-Immunology clinics of Hamad General Hospital during June 2014- June 2015 with severe AD. Variable Total No. of Patients 135 Age (months, mean±SD) 41.9 ±38.8 Sex Males78 (57.8%) Females57 (42.2% M/F Ratio1.37:1 Co-existing allergies Absent95 (70.4%) Present40 (29.6%) Family history of allergies Absent105 (77.8%) Present30 (22.2%) Positive food allergies Absent104 (77%) Present31 (23%) Table 1. Basic demographic data on 135 patents with severe AD Variable BMI (%)14.92±7.2 SCORAD61.3 ±22.3 WBC (Cells/Ul)11,826.7 ±3,992.3 Eosinophil (cells/Ul) 955 ±946.1 Low proteins 78 pats. (57.8%) Low albumin 43 pats. (35.5%) Table 2. Laboratory results of AD with low albumin and low proteins. Table 3. Relationship of biochemical test with growth and AD severity. (*= P <0.05) Biochemical status BMI (%) SCORAD (index) Low-Albumin11.2±2*67.9±22.1* Normal-Albumin19.1±38.158.3±22.5 Low-Protein11.2±1.2*73±21.1* Normal-protein 22.5±11.859.9±20.5 I.In severe AD, 58% of patients had hypoproteinemia. II.Hypoalbuminemia is associated with low BMI in 42% of patients. III.These findings denote a harmful effect of severe AD on albumin loss and growth. These effects are related to severity of AD. IV.It is important to closely monitor growth, nutrition and its biochemical makers (albumin, IGF-I) in the management of severe AD. This research was supported by a grant from Hamad Medical Corporation Research, No. 14193/14 Acknowledgments