Could Altered Red Cell Indices Reflect Oxidative Stress in Pediatric Atopic Dermatitis?
Methods: A retrospective, cross-sectional study was conducted involving 250 pediatric patients diagnosed with AD and 163 healthy controls. Hematological and biochemical parameters were obtained from hospital records, including complete blood count variables and serum levels of urea, creatinine, AST, ALT, uric acid, TSH, free T4, and vitamin B12. Data were analyzed using distribution assessments, intergroup comparisons, and Spearman correlation tests.
Results: Pediatric AD patients exhibited significant alterations in red cell indices. RDW-CV was markedly elevated and showed extreme positive skewness, indicating anisocytosis and disrupted erythropoiesis. RDW-CV strongly correlated with AST and ALT levels. Additionally, MCH positively correlated with vitamin B12 and TSH, while MCHC showed an inverse correlation with ALT.
Conclusions: Altered red blood cell indices, especially RDW-CV and MCH, may serve as accessible and cost-effective surrogate markers for systemic oxidative and metabolic stress in pediatric atopic dermatitis. These hematologic parameters could be integrated into routine assessments to support individualized treatment approaches and endotype-specific care strategies in pediatric populations.
1. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483-1494. doi: 10.1056/NEJMra074081.
2. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16. doi: 10.1159/000370220.
3. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109-1122. doi: 10.1016/S0140-6736(15)00149-X.
4. Leung DYM, Guttman-Yassky E. Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. J Allergy Clin Immunol. 2014;134(4):769-779. doi: 10.1016/j.jaci.2014.08.008.
5. Irvine AD, McLean WHI, Leung DYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011;365(14):1315-1327. doi: 10.1056/NEJMra1011040.
6. Brown SJ, McLean WHI. One remarkable molecule: filaggrin. J Invest Dermatol. 2012;132(3 Pt 2):751-762. doi: 10.1038/jid.2011.393.
7. Brunner PM, Israel A, Zhang N, et al. Early-onset pediatric atopic dermatitis is characterized by TH2/TH17/TH22-centered inflammation and lipid alterations. J Allergy Clin Immunol. 2018;141(6):2094-2106. doi: 10.1016/j.jaci.2018.02.040.
8. Renert-Yuval Y, Del Duca E, Pavel AB, et al. The molecular features of normal and atopic dermatitis skin in infants, children, adolescents, and adults. J Allergy Clin Immunol. 2021;148(1):148-163. doi: 10.1016/j.jaci.2021.01.001.
9. Andina D, Belloni-Fortina A, Bodemer C, et al; ESPD Group for the Skin Manifestations of COVID-19. Skin manifestations of COVID-19 in children: Part 1. Clin Exp Dermatol. 2021;46(3):444-450. doi: 10.1111/ced.14481.
10. Thijs JL, Nierkens S, Herath A, et al. A panel of biomarkers for disease severity in atopic dermatitis. Clin Exp Allergy. 2015;45(3):698-701. doi: 10.1111/cea.12486.
11. Holm JG, Hurault G, Agner T, et al. Immunoinflammatory Biomarkers in Serum Are Associated with Disease Severity in Atopic Dermatitis. Dermatology. 2021;237(4):513-520. doi: 10.1159/000514503.
12. Maintz L, Welchowski T, Herrmann N, et al; CK-CARE study group. IL-13, periostin and dipeptidyl-peptidase-4 reveal endotype-phenotype associations in atopic dermatitis. Allergy. 2023;78(6):1554-1569. doi: 10.1111/all.15647.
13. Kim HS, Kim JH, Seo YM, et al. Eosinophil-derived neurotoxin as a biomarker for disease severity and relapse in recalcitrant atopic dermatitis. Ann Allergy Asthma Immunol. 2017;119(5):441-445. doi: 10.1016/j.anai.2017.06.022.
14. Valko M, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007;39(1):44-84. doi: 10.1016/j.biocel.2006.07.001.
15. Bertino L, Guarneri F, Cannavò SP, Casciaro M, Pioggia G, Gangemi S. Oxidative Stress and Atopic Dermatitis. Antioxidants (Basel). 2020;9(3):196. doi: 10.3390/antiox9030196.
16. Sivaranjani N, Rao SV, Rajeev G. Role of reactive oxygen species and antioxidants in atopic dermatitis. J Clin Diagn Res. 2013;7(12):2683-2685. doi: 10.7860/JCDR/2013/6291.3784.
17. Karacan G, Ercan N, Bostanci I, Alisik M, Erel O. A novel oxidative stress marker of atopic dermatitis in infants: thiol-disulfide balance. Arch Dermatol Res. 2020;312(10):697-703. doi: 10.1007/s00403-020-02054-5.
18. Peroni DG, Bodini A, Corradi M, Coghi A, Boner AL, Piacentini GL. Markers of oxidative stress are increased in exhaled breath condensates of children with atopic dermatitis. Br J Dermatol. 2012;166(4):839-843. doi: 10.1111/j.1365-2133.2011.10771.x.
19. Nagata N, Hamasaki Y, Inagaki S, et al. Urinary lipid profile of atopic dermatitis in murine model and human patients. FASEB J. 2021;35(11):e21949. doi: 10.1096/fj.202100828R.
20. Ruan Z, Wang Y, Fan Y, et al. The relationship between red blood cell distribution width and long-term prognosis of asthma: a population-based study. Sci Rep. 2025;15(1):6487. doi: 10.1038/s41598-025-87469-8.
21. Horta-Baas G, Romero-Figueroa MDS. Clinical utility of red blood cell distribution width in inflammatory and non-inflammatory joint diseases. Int J Rheum Dis. 2019;22(1):47-54. doi: 10.1111/1756-185X.13332.
22. Liu H, Cheng J, Peng K, et al. Red Cell Distribution Width as a Predictive Biomarker for Early Lung Injury in Pediatric Patients Following Cardiopulmonary Bypass. Children (Basel). 2025;12(6):785. doi: 10.3390/children12060785.
23. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width: a powerful prognostic marker in heart failure. Eur J Heart Fail. 2010;12(4):415. doi: 10.1093/eurjhf/hfq018.
24. Aulakh R, Sohi I, Singh T, Kakkar N. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia. Indian J Pediatr. 2009;76(3):265-268. doi: 10.1007/s12098-009-0014-4.

Copyright (c) 2026 The European Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Downloads
Article Information
- Article Type Research Article
- Submitted February 21, 2026
- Published April 1, 2026
- Issue Volume 12 - Issue 4 (April 2026)
- Section Research Article