Imaging-guided tape stripping reveals consistent stratum corneum profiling of disease severity and treatment-responsive molecular features in pediatric atopic dermatitis

Abstract

Background

Atopic dermatitis (AD) is a common pediatric skin disorder with early onset and complex pathophysiology. Tape-strip sampling has enabled minimally invasive molecular profiling of skin lesions in children, yet approaches that verify and standardize stratum corneum (SC) sampling depth have remained limited.

Objective

To evaluate the utility of imaging-guided tape stripping of SC, combined with transcriptomic and cytokine profiling, for characterizing molecular changes associated with disease severity and treatment response in pediatric AD.

Methods

By coupling real-time imaging-guided tape stripping with RNA sequencing and cytokine profiling, we examined SC molecular signatures in healthy children (n = 15) and lesional and non-lesional skin of pediatric AD patients (n = 39) with heterogeneous disease severity, both at baseline and following 2 weeks of topical corticosteroid treatment.

Results

Using imaging-verified SC sampling, we identified robust molecular signatures, including > 1100 differentially expressed genes (DEGs) between healthy and AD skin, and 144 DEGs between lesional and non-lesional AD skin (fold-change ≥2, FDR <0.1). Lesional skin showed enrichment of type 17- and type 2-associated immune pathways, tissue remodeling, and cell cycle control. Thirteen transcripts were significantly associated with clinical severity or itch, including CXCL8/IL8, CD300A, and FPR1. Most of these transcripts decreased after corticosteroid treatment, whereas CD300A and FCGR2B/CD32 remained elevated in a subset of children.

Conclusion

These findings support the use of real-time imaging-guided tape stripping as a standardized, minimally invasive approach for verifying SC sampling depth and monitoring molecular changes associated with disease activity and treatment response in pediatric AD.