Skin barrier function in children with eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is associated with epithelial barrier dysfunction of the esophagus. Studies suggest that the skin lipidomic profile is altered in EoE; therefore, we hypothesized that skin barrier function would be compromised in subjects with EoE.

We aimed to evaluate skin barrier function in subjects with EoE by assessing transepidermal water loss (TEWL).

We performed a single-center, case-control study of pediatric subjects with known EoE and controls without EoE. The subjects with EoE met consensus criteria for diagnosis. Patients receiving systemic biologic medications or prescription topical corticosteroids were excluded. A majority of the subjects with EoE underwent a concurrent esophageal string test or had a recent endoscopy near the time of TEWL assessment. In addition to comparing subjects with EoE and controls without EoE, we compared TEWL according to EoE disease activity.

The subjects with EoE (n = 25) were older than the controls without EoE (n = 24) but similar from the standpoint of other demographic features. The controls were primarily atopic (79.2%). Rate of TEWL was comparable in the subjects with EoE and the controls (median =15.1 [interquartile range = 4.95] g/m² per hour vs median = 16.9 [interquartile range = 7.3] g/m² per hour [P = .18]); differences between those subjects with active EoE (n = 10) and those with inactive EoE (n = 14) were not observed. A subgroup analysis excluding patients with atopic dermatitis did not reveal differences in TEWL among the subjects with EoE.

Subjects with EoE did not have marked skin barrier dysfunction relative to the controls without EoE and TEWL did not vary according to disease activity. These findings suggest that the utility of TEWL as a biomarker of EoE is limited. Larger studies with defined atopic and nonatopic controls are needed to detect small to moderate differences in skin barrier function.