CONCLUSION: A changed innervation and modulation of the serotonergic
system are indicated in chronic atopic eczema also during chronic
stress.

OBJECTIVE: To identify pathoaetiological neuroimmune mechanisms in
patients with atopic dermatitis (AD) and chronic stress, focusing at
nerve density, sensory neuropeptides, and the serotonergic system.

METHODS: Eleven patients with AD with histories of stress worsening
were included. Biopsies from involved and non-involved skin were
processed for immunohistochemistry. Salivary cortisol test was done as
a marker for chronic stress.

RESULTS: There were more acanthosis and
fewer nerve fibres in epidermis and papillary dermis of involved
compared with non-involved skin. Whereas there was no significant
change in the number of substance P and calcitonin gene-related
peptide-positive nerve fibres between the involved and non-involved
skin, there was an increase in the epidermal fraction of
5-hydroxtrytamine 1A (5-HT1A) receptor and serotonin transporter
protein (SERT) immunoreactivity in the involved skin. The number of
5-HT2AR, CD3-positive cells, and SERT-positive cells, most of them
being CD3 positive, was increased in involved skin. There was an
increase in mast cells in the involved skin, and these cells were often
located close to the basement membrane. There was a strong tendency to
a correlation between 5-HT2AR positive cells in the papillary dermis of
involved skin and low cortisol ratios, being an indicator of chronic
stress.

CONCLUSION: A changed innervation and modulation of the
serotonergic system are indicated in chronic atopic eczema also during
chronic stress.

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