23
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Hair Mineral Analysis in Children with Atopic Dermatitis

      brief-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Dear Editor: Minerals and essential elements are important components of nutrition1. These elements play crucial roles in the normal functioning of the immune system and antioxidant mechanisms which are related to the pathogenesis of atopic dermatitis (AD)2. Previous studies have hypothesized that AD is associated with a non-specific decrease concerning trace metals3 4. Furthermore, we previously reported that zinc (Zn) supplementation led to clinical improvement in AD patients with low hair Zn levels5. However, there is little data on other hair mineral levels in AD. Therefore, the aim of this study was to analyze the concentrations of trace elements in hair and to evaluate their relevance to disease severity in children with AD. A total of 66 children (37 boys, 29 girls; mean age, 5.88 years; range, 1~14 years) with confirmed diagnoses of mild to moderate AD (eczema area and severity index [EASI] scores <26) were enrolled. A sex- and age-matched control group consisted of 25 children (15 boys, 10 girls; mean age, 6.12 years; range, 2~12 years) without dermatological disorders. The study protocol was approved by the ethics committee at Hanyang University Seoul Hospital (IRB no. 2011-R-34). Participants were asked not to chemically process their hair for at least 8 weeks prior to mineral analysis. Mineral measurements were performed using a microwave temperature-controlled digestion technique and Perkin-Elmer Mass Spectrometer (SciexElan 6100; Perkin-Elmer Corporation, Foster City, CA, USA)6. The mineral concentrations are expressed as mg% (mg/100 g of hair). The reference ranges determined by US Trace Elements Inc. (TEI), which has been derived comprehensively from numerous data and widely used in the several studies, were used in this study. The EASI score, trans-epidermal water loss (TEWL) using a Tewameter TM210® (Courage & Khazaka, Cologne, Germany), and visual analogue scales (VAS) for pruritus and sleep disturbance were assessed. Fifteen nutritional elements and seven toxic elements were analyzed. The nutritional elements included calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), copper (Cu), Zn, phosphate (P), iron (Fe), manganese (Mn), chromium (Cr), selenium (Se), boron (B), cobalt (Co), molybdenum (Mo), and sulfur (S). The toxic elements included uranium (U), arsenic (As), beryllium (Be), mercury (Hg), cadmium (Cd), lead (Pb), and aluminum (Al). Among the nutritional elements, Ca, Mg, Cu, Zn, P levels were statistically lower and Na, K, Mn, Cr, and Mo levels were statistically higher in the AD patients compared to those in the control group. However, the mean levels of all these minerals were within the TEI reference ranges, except for K, which was higher than the reference range. Among the toxic minerals, Cd, Pb and As were significantly higher in AD patients than in control patients. In both groups, the mean levels of Cd and Pb were below the lower reference limit. Similarly, the mean level of As was within the reference range in the AD patients (Table 1). Next, we analyzed the significance of the relationship between numerical value of minerals that showed difference between two groups and the parameters of clinical severity and found a statistical significance for a few minerals. The increased levels of K in AD patients were negatively correlated with EASI scores. The Cd level was positively correlated with TEWL, but the mean level of Cd in AD patients was lower than the normal reference range. Although there was a statistical significance between Mo level and VAS for pruritus, they showed a weak correlation (Table 2). Based on the clinical parameters used, we did not find that these minerals were clinically relevant to AD. There is growing interest in the role of minerals and micronutrients in AD. There have been several studies on mineral concentrations in AD patients, but the reported results have been contradictory. Zn is the most widely studied mineral that has clinical relevance in AD patients3 4. In this study, we found that the hair Zn level was significantly lower in AD patients as in our previous study5. Ca is involved in cellular physiology and is a major component of bone and teeth mineralization. Mg is an essential mineral that plays a critical role in the immune response. The lower levels of Ca and Mg in AD patients may reflect an avoidance of dairy products and nuts. Cu is an essential trace element in antioxidant systems and DNA synthesis7. Hon et al.4 suggested that the Cu/Zn ratio were increased in AD patients and positively correlated with the clinical severity3 4 8. However, in this study, there was no difference in the Cu/Zn ratio between the two groups or correlation with the clinical severity. This discrepancy between studies may result from differences in nutritional habits, age, or study methodology. K was the only element whose level exceeded the upper limit of the reference range in AD patients. However, since essential minerals interact with one another, there could be an imbalance in AD patients9. There seems to be low risk of environmental hazards from heavy metal intoxication in Korean children with AD, because levels of toxic elements which were significantly higher in AD patients than in normal controls were below or within the reference ranges. Regardless, caution must be taken to prevent intoxication with such elements in AD patients. To our knowledge, no previous studies have evaluated the hair levels of various mineral levels in AD patients and established a relationship between the clinical severity and the mineral levels. Despite some differences between the two groups with regard to mineral levels, we did not find meaningful clinical relevance between the severity of AD and the micronutrient levels. Although we did not evaluate the subjects' diets, the levels of trace elements may have differed due to nutritional imbalances in atopic patients. Nevertheless, most mineral levels were within the reference ranges. This finding indicates that atopic children did not have severe mineral deficiencies. Based on our findings, mildly reduced mineral levels are likely insufficient to produce clinical changes10. Large supplementation trials are needed to assess the clinical efficacy of replacing depleted minerals in AD patients. Indiscriminate commercial exploitation of mineral supplement product should be sublated before the confirmation of therapeutic effects of mineral supplementation.

          Related collections

          Most cited references9

          • Record: found
          • Abstract: found
          • Article: not found

          Iron and copper metabolism.

          Iron and copper are essential nutrients, excesses or deficiencies of which cause impaired cellular functions and eventually cell death. The metabolic fates of copper and iron are intimately related. Systemic copper deficiency generates cellular iron deficiency, which in humans results in diminished work capacity, reduced intellectual capacity, diminished growth, alterations in bone mineralization, and diminished immune response. Copper is required for the function of over 30 proteins, including superoxide dismutase, ceruloplasmin, lysyl oxidase, cytochrome c oxidase, tyrosinase and dopamine-beta-hydroxylase. Iron is similarly required in numerous essential proteins, such as the heme-containing proteins, electron transport chain and microsomal electron transport proteins, and iron-sulfur proteins and enzymes such as ribonucleotide reductase, prolyl hydroxylase phenylalanine hydroxylase, tyrosine hydroxylase and aconitase. The essentiality of iron and copper resides in their capacity to participate in one-electron exchange reactions. However, the same property that makes them essential also generates free radicals that can be seriously deleterious to cells. Thus, these seemingly paradoxical properties of iron and copper demand a concerted regulation of cellular copper and iron levels. Here we review the most salient characteristics of their homeostasis.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Dietary antioxidants: immunity and host defense.

            Natural antioxidants may be defined as molecules that prevent cell damage against free radicals and are critical for maintaining optimum health in both animals and humans. In all living systems, cells require adequate levels of antioxidant defenses in order to avoid the harmful effect of an excessive production of reactive oxygen species (ROS) and to prevent damage to the immune cells. During the inflammatory processes, the activation of phagocytes and/or the action of bacterial products with specific receptors are capable of promoting the assembly of the multicomponent flavoprotein NADPH oxidase, which catalyzes the production of high amounts of the superoxide anion radical (O(2)(-)). Under these particular circumstances, neutrophils and macrophages are recognized to produce superoxide free radicals and H(2)O(2), which are essential for defence against phagocytized or invading microbes. In this state, antioxidants are absolutely necessary to regulate the reactions that release free radicals. Antioxidant nutrients commonly included in the diet such as vitamin E, vitamin C, β-carotene, selenium, copper, iron and zinc improve different immune function exhibiting an important protective role in infections caused by bacteria, viruses or parasites. As a result, dietary antioxidants have been related to modulate the host susceptibility or resistance to infectious pathogens. Overall, numerous studies have suggested that the development of tolerance, and control of inflammation are strongly correlated with specific immune mechanisms that may be altered by an inadequate supply of either macronutrients or micronutrients. Therefore, the present paper will review the effects of dietary antioxidants on immune cell function and the impact on protection against infectious microorganisms.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Hair zinc levels and the efficacy of oral zinc supplementation in patients with atopic dermatitis.

              Zinc deficiency in patients with atopic dermatitis (AD) and the use of zinc supplementation is still controversial. We measured hair zinc levels in 58 children with AD and 43 controls (age range 2-14 years). We also investigated the efficacy of oral zinc supplementation in AD patients with low hair zinc levels by comparing eczema assessment severity index (EASI), transepidermal water loss (TEWL), and visual analogue scales for pruritus and sleep disturbance in patients receiving zinc supplementation (Group A) and others not receiving supplementation (Group B). At baseline, the mean zinc level was significantly reduced in AD patients (113.1 μg/g vs. 130.9 μg/g, p = 0.012). After 8 weeks of supplement, hair zinc level increased significantly in Group A (p < 0.001), and EASI scores, TEWL, and visual analogue scales for pruritus improved more in Group A than in Group B (p = 0.044, 0.015 and < 0.001, respectively). Thus, oral zinc supplementation may be effective in AD patients with low hair zinc levels.
                Bookmark

                Author and article information

                Journal
                Ann Dermatol
                Ann Dermatol
                AD
                Annals of Dermatology
                The Korean Dermatological Association; The Korean Society for Investigative Dermatology
                1013-9087
                2005-3894
                April 2017
                24 March 2017
                : 29
                : 2
                : 251-253
                Affiliations
                Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Young Suck Ro, Department of Dermatology, Hanyang University Seoul Hospital, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: 82-2-2290-8441, Fax: 82-2-2291-9619, romio@ 123456hanyang.ac.kr
                Article
                10.5021/ad.2017.29.2.251
                5383762
                257b46f5-7b58-474b-84e7-828628e67eec
                Copyright © 2017 The Korean Dermatological Association and The Korean Society for Investigative Dermatology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 December 2015
                : 18 April 2016
                : 27 April 2016
                Categories
                Brief Report

                Dermatology
                Dermatology

                Comments

                Comment on this article