Association of systemic inflammatory markers and serum immunoglobulin E levels with severity of atopic dermatitis

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease with multifactorial pathogenesis and variable clinical manifestations that significantly impair quality of life. Scoring atopic dermatitis (SCORAD) index is widely used to assess severity but remains subjective and dependent on trained assessors. Systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), eosinophil-to-neutrophil ratio (ENR), platelet-to-lymphocyte ratio (PLR), and serum immunoglobulin E (IgE) may serve as more objective indicators. This study aimed to evaluate the association between these systemic inflammatory markers, serum IgE levels, and AD severity. An analytic cross-sectional study was conducted on 36 AD patients attending the Dermatology and Venereology outpatient clinic at Mohammad Hoesin Hospital Palembang from April to June 2025. Disease severity was assessed using the SCORAD index and categorized as mild–moderate or severe. Systemic inflammatory markers were derived from complete blood count results, and serum IgE levels were measured using immunoserological assays. ELR and serum IgE levels showed significant associations with AD severity, with higher mean values in the severe group (p<0.05). Multivariate analysis indicated that ELR >0.217 and serum IgE >418.65 IU/mL were associated with 22.3-fold and 42-fold increased risks of severe AD, respectively. The Th2-dominant immune response in AD, involving IL-4, IL-5, and IL-13, underlies elevated eosinophil activity and IgE overproduction. ELR and serum IgE levels are significantly associated with AD severity and may serve as objective markers for assessing disease severity.