ELEVATION OF TOTAL SERUM IGE AS A PREDICTIVE BIOMARKER FOR RECURRENCE AND TREATMENT RESISTANCE IN NON-ATOPIC ADULT DERMATOMYCOSES

Abstract

Dermatophytoses represent a major global health concern, with a rising occurrence of recurrent, persistent and treatment resistant clinical chronic cases. Even though cell mediated immunity (Th1/Th17) is the main mechanism accountable for clearing dermatophyte infections, the role of type I hypersensitivity mediated humoral immune responses implicated in successful treatment setbacks has not been thoroughly or adequately investigated in clinical studies (Sardana et al., 2021; Woodfolk, 2005). This study presents the comprehensive evaluation of total serum Immunoglobulin E (IgE) as a predictive biomarker for the assessment of disease recurrence and identifying the host susceptibility factors in adult patients with active chronic dermatomycoses who do not present clinical signs of cutaneous atopy nor is it present in their medical history. This aids to provide a much thorough medical understanding of the immunological factors and mechanism that play a role in recurrent or persistent infections in individuals lacking obvious atopic skin diseases.
In this cross sectional cohort study a total of 120 adult patients were included, all of which contained superficial dermophyte infections confirmed with both fungal cultures as well as direct potassium hydroxide (KOH). Patients were diagnosed with tinea cruris, tinea corporis and tinea pedis and divided into two clinical groups based on their disease course. Group A consisted of 60 patients with treatment resistant infections, characterized by at least three episodes over the preceding 12 months despite appropriate medical antifungal treatment. Group B comprised of 60 patients experiencing their first episode of acute dermatophytosis. For the measurement of Total serum IgE. The chemiluminescent immunoassay (CLIA) was used with values below 100 IU/mL considered within the normal range. In order to minimize the confounding factors, patients that had conditions known to affect serum IgE levels were excluded such as; active atopic dermatitis, concurrent parasitic infections, allergic rhinitis.
An elevation in total serum IgE levels (> 100 IU/mL) was observed in 47 out of 60 patients (78.3%) with recurrent dermatophytosis (Group A), compared with solely 13 out of 60 patients in the acute infection group (Group B), thus presenting a statistically significant difference (p < 0.0001). Supporting this observation, the mean serum IgE concentration was markedly higher in Group A (584.2 ± 112.4 IU/mL) as opposed to Group B (112.6 ± 34.1IU/mL).
Trichophyton rubrum was, among the fungal species, the most frequently identified species, with 68.3% of positive cultures, followed by Trichophyton mentagrophytes (24.2%). ROC curve analysis identified 320 IU/mL as the optimal serum IgE cutoff for predicting recurrent treatment failure, achieving a sensitivity of 83.3%, a specificity of 88.3%, and an AUC of 0.912.
Subclinical elevation in the levels of total serum IgE among patients lacking atopic disease may reflect a subtle Th2 skewed immune profile that plays a role in the host immune responses and affects the effectiveness of fungal clearance. The incorporation of baseline serum IgE assessment in routine dermatological evaluation presents a very useful as well as necessary prognostic approach in identifying individuals that are most likely to have a recurrence in fungal infections and who need a more customized therapeutic approach.