A practical tool for differentiating Job’s syndrome from atopic dermatitis: a preliminary study

Introduction
Several errors in mechanisms of specific antigen response are manifested as cutaneous inflammation. Some clinical features required to fulfil the diagnostic criteria are inapplicable to paediatric patients, as they develop over a prolonged period of time or in older age. Effective treatment requires identification of the defective mechanism. Biopsy of the lesions is considered a gold standard in diagnostics; however invasive methods should be avoided in children. Cytokine-producing T helper cells are important players in skin immune homeostasis. Distribution of selected subsets in peripheral blood has been reported to be altered in various diseases. Practical use of their enumeration was limited until recently for technical reasons, but also due to lack of normal values known to change with age.

Aim
This study was performed in order to verify whether the distribution of the cytokine-producing T helper subsets identified by expression of selected surface markers can be used for diagnostic purposes.

Material and methods
Forty two subjects in the healthy control group and 40 patients with severe skin lesions, including 12 with Job’s syndrome, were enrolled in the study. Peripheral blood samples for identification of cytokine-producing T helper subsets were analysed by flow cytometry.

Results
We found a significant reduction of Th17 in Job’s syndrome and excess of Th2 in the atopic dermatitis group in relation to normal age-related/matched controls.

Conclusions
The developed normal age-related ranges allowed to discriminate between patients with similar lesions of different origin and to shorten the diagnostic delay in patients requiring a different treatment strategy.