Biomechanical alterations of the spine correlated with the severity of dermatitis and calcitonin gene-related peptide levels Spinal alterations and atopic dermatitis
Main Article Content
Abstract
Background: Intrinsic atopic dermatitis is a chronic cutaneous inflammatory disease with pruritus and eczematous lesions of skin. A long-lasting cycle of itch-scratch roots results in substantial morbidities and discomfort. Treatment of patients with moderate to severe dermatitis is a challenge.
Objectives: A) To characterize the relationship between spinal biomechanical alterations, the severity of intrinsic atopic dermatitis, and the blood levels of calcitonin gene-related peptide (CGRP) and B) to determine whether chiropractic spinal manipulative therapy can be an effective complementary treatment.
Materials and Methods: In this prospective study, 33 patients with severity index (EASI) score less than 7 were compared with 40 patients with EASI score greater than 7. The severity level of spine biomechanical alterations (spinal biomechanical alterations) was quantified using full spine radiographic descriptions. The expression of CGRP was determined in blood using ELISA tests. All patients were prescribed the same anti-inflammatory topical cream. Of the 73 patients, 51 choose to be also treated by chiropractic and the 22 others were used as control. Data were analyzed before and after the treatment.
Results: A strong correlation was found between overall spinal biomechanical modifications, altered skin status and CGRP levels. The EASI scores were correlated with the different segments of the spine. Although the EASI score of the patients in the control group decreased after 2 weeks of using the anti-inflammatory cream, 3 months later the dermatitis symptoms flared up again and the EASI scores returned to baseline values. In contrast, both the EASI scores and the CGRP levels of treated patients by chiropractic remained low after 3 months.
Conclusions: This study shows that the severity of intrinsic dermatitis is related to that of spinal biomechanical alterations, and that CGRP levels may serve as a valuable pathological marker. Chiropractic proved to be a valuable complementary therapeutic tool.
Keywords:
Chiropractic, CGRP, Column, Dermatitis, Dermatology, Spine
Article Details
How to Cite
KHORSANDI, Danial et al.
Biomechanical alterations of the spine correlated with the severity of dermatitis and calcitonin gene-related peptide levels.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6283>. Date accessed: 16 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6283.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Leung DY, Bieber T. Atopic dermatitis. Lancet 2003; 361: 151-60.
2. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-60.
3. Kader HA, Azeem M, Jwayed SA et al. Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis. Cells 2021; 10.
4. Roguedas AM, Machet L, Fontes V et al. [Atopic dermatitis: which are the diagnostic criteria used in medical literature?]. Ann. Dermatol. Venereol. 2004; 131: 161-4.
5. Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int 2022; 71: 14-24.
6. Misery L. Atopic dermatitis and the nervous system. Clin Rev Allergy Immunol 2011; 41: 259-66.
7. Fan J, Mishra SK. The emerging role of neuroimmune interactions in atopic dermatitis and itch. FEBS J 2022; 289: 2723-35.
8. Zhang Y, Zhang H, Jiang B et al. Current views on neuropeptides in atopic dermatitis. Exp. Dermatol. 2021; 30: 1588-97.
9. Marek-Jozefowicz L, Nedoszytko B, Grochocka M et al. Molecular Mechanisms of Neurogenic Inflammation of the Skin. Int. J. Mol. Sci. 2023; 24.
10. Garg NK, Silverberg JI. Eczema is associated with osteoporosis and fractures in adults: a US population-based study. JACI 2015; 135: 1085-7 e2.
11. Lowe KE, Mansfield KE, Delmestri A et al. Atopic eczema and fracture risk in adults: A population-based cohort study. JACI 2020; 145: 563-71 e8.
12. Bieber T. Atopic dermatitis. NEJM 2008; 358: 1483-94.
13. Leshem YA, Hajar T, Hanifin JM et al. What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study. BJD 2015; 172: 1353-7.
14. Hanifin JM, Thurston M, Omoto M et al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp. Dermatol. 2001; 10: 11-8.
15. Silverberg JI, Lei D, Yousaf M et al. What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. BJD 2021; 184: 888-95.
16. Harrop JS, Vaccaro AR, Hurlbert RJ et al. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. J. Neurosurg. Spine 2006; 4: 118-22.
17. Lee JY, Vaccaro AR, Lim MR et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J. Orthop. Sci. 2005; 10: 671-5.
18. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J. Neurosurg. Spine 2007; 6: 222-8.
19. Kaale BR, Krakenes J, Albrektsen G et al. Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J. Neurotrauma 2005; 22: 466-75.
20. Hasegawa K, Kitahara K, Shimoda H et al. Facet joint opening in lumbar degenerative diseases indicating segmental instability. J. Neurosurg. Spine 2010; 12: 687-93.
21. Lotz JC, Haughton V, Boden SD et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology 2012; 264: 6-19.
22. Garg A, Kapellusch JM. Applications of biomechanics for prevention of work-related musculoskeletal disorders. Ergonomics 2009; 52: 36-59.
23. Anderson PA, Moore TA, Davis KW et al. Cervical spine injury severity score. Assessment of reliability. J. Bone Joint Surg. Am. 2007; 89: 1057-65.
24. Umbert I, Sans G, Valls J et al. EP2311454 treatment for atopic dermatitis: therapeutic efficiency in patients and anti-inflammatory in vitro. Clin. Dermatol. 2017; 5: 5-11.
25. Trager RJ, Bejarano G, Perfecto RT et al. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. J. Clin. Med. 2024; 13.
26. Young KJ, Leboeuf-Yde C, Gorrell L et al. Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropr. Man. Ther. 2024; 32: 28.
27. Rubinstein SM, de Zoete A, van Middelkoop M et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364: l689.
28. Qaseem A, Wilt TJ, McLean RM et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann. Intern. Med. 2017; 166: 514-30.
29. Haavik H, Kumari N, Holt K et al. The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur. J. Appl. Physiol. 2021; 121: 2675-720.
30. Bussieres AE, Stewart G, Al-Zoubi F et al. Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther 2018; 41: 265-93.
31. Le Huec JC, Thompson W, Mohsinaly Y et al. Sagittal balance of the spine. Eur. Spine J. 2019; 28: 1889-905.
32. Ling FP, Chevillotte T, Leglise A et al. Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur. Spine J. 2018; 27: 8-15.
33. Blair MJ, Jones JD, Woessner AE et al. Skin Structure-Function Relationships and the Wound Healing Response to Intrinsic Aging. Adv. Wound Care 2020; 9: 127-43.
34. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br. J. Dermatol. 2020; 182: 47-54.
35. Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs Aging 2020; 37: 149-60.
36. Wang S, Zhu R, Gu C et al. Distinct clinical features and serum cytokine pattern of elderly atopic dermatitis in China. JEADV 2020; 34: 2346-52.
37. Coskun Benlidayi I, Basaran S. Comparative study of lumbosacral alignment in elderly versus young adults: data on patients with low back pain. ACER 2015; 27: 297-302.
38. Jinkins JR. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiskal structures of the spinal column and perispinal soft tissues. Radiol Clin North Am 2001; 39: 73-99.
39. Galbusera F, van Rijsbergen M, Ito K et al. Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility. Eur. Spine J. 2014; 23 Suppl 3: S324-32.
40. Stecco C, Pirri C, Fede C et al. Dermatome and fasciatome. Clin. Anat. 2019; 32: 896-902.
41. Park JHM, Kang SYP, Lee SGP et al. The effects of smart phone gaming duration on muscle activation and spinal posture: Pilot study. Physiother. Theory Pract. 2017; 33: 661-9.
42. Rodriguez-Sanz J, Carrasco-Uribarren A, Cabanillas-Barea S et al. Validity and reliability of two Smartphone applications to measure the lower and upper cervical spine range of motion in subjects with chronic cervical pain. J Back Musculoskelet Rehabil 2019; 32: 619-27.
43. Burgos J, Barrios C, Mariscal G et al. Non-uniform Segmental Range of Motion of the Thoracic Spine During Maximal Inspiration and Exhalation in Healthy Subjects. Front. Med. 2021; 8: 699357.
44. Morita D, Yukawa Y, Nakashima H et al. Range of motion of thoracic spine in sagittal plane. Eur. Spine J. 2014; 23: 673-8.
45. Liyew WA. Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions. Int. J. Rheumatol. 2020; 2020: 2919625.
46. Brooks BK, Southam SL, Mlady GW et al. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain. Skelet. Radiol. 2010; 39: 669-73.
47. Wesselmann U. Neurogenic inflammation and chronic pelvic pain. World J. Urol. 2001; 19: 180-5.
48. Steinhoff M, Ahmad F, Pandey A et al. Neuroimmune communication regulating pruritus in atopic dermatitis. JACI 2022; 149: 1875-98.
49. Krock E, Rosenzweig DH, Chabot-Dore AJ et al. Painful, degenerating intervertebral discs up-regulate neurite sprouting and CGRP through nociceptive factors. J Cell Mol Med 2014; 18: 1213-25.
50. Krock E, Currie JB, Weber MH et al. Nerve Growth Factor Is Regulated by Toll-Like Receptor 2 in Human Intervertebral Discs. J. Biol. Chem. 2016; 291: 3541-51.
51. Pahor M, Guralnik JM, Ambrosius WT et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311: 2387-96.
52. Keadle SK, McKinnon R, Graubard BI et al. Prevalence and trends in physical activity among older adults in the United States: A comparison across three national surveys. Prev. Med. 2016; 89: 37-43.
53. Haeck IM, Hamdy NA, Timmer-de Mik L et al. Low bone mineral density in adult patients with moderate to severe atopic dermatitis. BJD 2009; 161: 1248-54.
54. Tadicherla S, Ross K, Shenefelt PD et al. Topical corticosteroids in dermatology. JDD 2009; 8: 1093-105.
55. Elmariah SB. Adjunctive Management of Itch in Atopic Dermatitis. Dermatol. Clin. 2017; 35: 373-94.
56. Vieira BL, Lim NR, Lohman ME et al. Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review. Am. J. Clin. Dermatol. 2016; 17: 557-81.
2. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-60.
3. Kader HA, Azeem M, Jwayed SA et al. Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis. Cells 2021; 10.
4. Roguedas AM, Machet L, Fontes V et al. [Atopic dermatitis: which are the diagnostic criteria used in medical literature?]. Ann. Dermatol. Venereol. 2004; 131: 161-4.
5. Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int 2022; 71: 14-24.
6. Misery L. Atopic dermatitis and the nervous system. Clin Rev Allergy Immunol 2011; 41: 259-66.
7. Fan J, Mishra SK. The emerging role of neuroimmune interactions in atopic dermatitis and itch. FEBS J 2022; 289: 2723-35.
8. Zhang Y, Zhang H, Jiang B et al. Current views on neuropeptides in atopic dermatitis. Exp. Dermatol. 2021; 30: 1588-97.
9. Marek-Jozefowicz L, Nedoszytko B, Grochocka M et al. Molecular Mechanisms of Neurogenic Inflammation of the Skin. Int. J. Mol. Sci. 2023; 24.
10. Garg NK, Silverberg JI. Eczema is associated with osteoporosis and fractures in adults: a US population-based study. JACI 2015; 135: 1085-7 e2.
11. Lowe KE, Mansfield KE, Delmestri A et al. Atopic eczema and fracture risk in adults: A population-based cohort study. JACI 2020; 145: 563-71 e8.
12. Bieber T. Atopic dermatitis. NEJM 2008; 358: 1483-94.
13. Leshem YA, Hajar T, Hanifin JM et al. What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis: an interpretability study. BJD 2015; 172: 1353-7.
14. Hanifin JM, Thurston M, Omoto M et al. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp. Dermatol. 2001; 10: 11-8.
15. Silverberg JI, Lei D, Yousaf M et al. What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. BJD 2021; 184: 888-95.
16. Harrop JS, Vaccaro AR, Hurlbert RJ et al. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. J. Neurosurg. Spine 2006; 4: 118-22.
17. Lee JY, Vaccaro AR, Lim MR et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J. Orthop. Sci. 2005; 10: 671-5.
18. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J. Neurosurg. Spine 2007; 6: 222-8.
19. Kaale BR, Krakenes J, Albrektsen G et al. Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J. Neurotrauma 2005; 22: 466-75.
20. Hasegawa K, Kitahara K, Shimoda H et al. Facet joint opening in lumbar degenerative diseases indicating segmental instability. J. Neurosurg. Spine 2010; 12: 687-93.
21. Lotz JC, Haughton V, Boden SD et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology 2012; 264: 6-19.
22. Garg A, Kapellusch JM. Applications of biomechanics for prevention of work-related musculoskeletal disorders. Ergonomics 2009; 52: 36-59.
23. Anderson PA, Moore TA, Davis KW et al. Cervical spine injury severity score. Assessment of reliability. J. Bone Joint Surg. Am. 2007; 89: 1057-65.
24. Umbert I, Sans G, Valls J et al. EP2311454 treatment for atopic dermatitis: therapeutic efficiency in patients and anti-inflammatory in vitro. Clin. Dermatol. 2017; 5: 5-11.
25. Trager RJ, Bejarano G, Perfecto RT et al. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. J. Clin. Med. 2024; 13.
26. Young KJ, Leboeuf-Yde C, Gorrell L et al. Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropr. Man. Ther. 2024; 32: 28.
27. Rubinstein SM, de Zoete A, van Middelkoop M et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364: l689.
28. Qaseem A, Wilt TJ, McLean RM et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann. Intern. Med. 2017; 166: 514-30.
29. Haavik H, Kumari N, Holt K et al. The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur. J. Appl. Physiol. 2021; 121: 2675-720.
30. Bussieres AE, Stewart G, Al-Zoubi F et al. Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther 2018; 41: 265-93.
31. Le Huec JC, Thompson W, Mohsinaly Y et al. Sagittal balance of the spine. Eur. Spine J. 2019; 28: 1889-905.
32. Ling FP, Chevillotte T, Leglise A et al. Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur. Spine J. 2018; 27: 8-15.
33. Blair MJ, Jones JD, Woessner AE et al. Skin Structure-Function Relationships and the Wound Healing Response to Intrinsic Aging. Adv. Wound Care 2020; 9: 127-43.
34. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br. J. Dermatol. 2020; 182: 47-54.
35. Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs Aging 2020; 37: 149-60.
36. Wang S, Zhu R, Gu C et al. Distinct clinical features and serum cytokine pattern of elderly atopic dermatitis in China. JEADV 2020; 34: 2346-52.
37. Coskun Benlidayi I, Basaran S. Comparative study of lumbosacral alignment in elderly versus young adults: data on patients with low back pain. ACER 2015; 27: 297-302.
38. Jinkins JR. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiskal structures of the spinal column and perispinal soft tissues. Radiol Clin North Am 2001; 39: 73-99.
39. Galbusera F, van Rijsbergen M, Ito K et al. Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility. Eur. Spine J. 2014; 23 Suppl 3: S324-32.
40. Stecco C, Pirri C, Fede C et al. Dermatome and fasciatome. Clin. Anat. 2019; 32: 896-902.
41. Park JHM, Kang SYP, Lee SGP et al. The effects of smart phone gaming duration on muscle activation and spinal posture: Pilot study. Physiother. Theory Pract. 2017; 33: 661-9.
42. Rodriguez-Sanz J, Carrasco-Uribarren A, Cabanillas-Barea S et al. Validity and reliability of two Smartphone applications to measure the lower and upper cervical spine range of motion in subjects with chronic cervical pain. J Back Musculoskelet Rehabil 2019; 32: 619-27.
43. Burgos J, Barrios C, Mariscal G et al. Non-uniform Segmental Range of Motion of the Thoracic Spine During Maximal Inspiration and Exhalation in Healthy Subjects. Front. Med. 2021; 8: 699357.
44. Morita D, Yukawa Y, Nakashima H et al. Range of motion of thoracic spine in sagittal plane. Eur. Spine J. 2014; 23: 673-8.
45. Liyew WA. Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions. Int. J. Rheumatol. 2020; 2020: 2919625.
46. Brooks BK, Southam SL, Mlady GW et al. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain. Skelet. Radiol. 2010; 39: 669-73.
47. Wesselmann U. Neurogenic inflammation and chronic pelvic pain. World J. Urol. 2001; 19: 180-5.
48. Steinhoff M, Ahmad F, Pandey A et al. Neuroimmune communication regulating pruritus in atopic dermatitis. JACI 2022; 149: 1875-98.
49. Krock E, Rosenzweig DH, Chabot-Dore AJ et al. Painful, degenerating intervertebral discs up-regulate neurite sprouting and CGRP through nociceptive factors. J Cell Mol Med 2014; 18: 1213-25.
50. Krock E, Currie JB, Weber MH et al. Nerve Growth Factor Is Regulated by Toll-Like Receptor 2 in Human Intervertebral Discs. J. Biol. Chem. 2016; 291: 3541-51.
51. Pahor M, Guralnik JM, Ambrosius WT et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311: 2387-96.
52. Keadle SK, McKinnon R, Graubard BI et al. Prevalence and trends in physical activity among older adults in the United States: A comparison across three national surveys. Prev. Med. 2016; 89: 37-43.
53. Haeck IM, Hamdy NA, Timmer-de Mik L et al. Low bone mineral density in adult patients with moderate to severe atopic dermatitis. BJD 2009; 161: 1248-54.
54. Tadicherla S, Ross K, Shenefelt PD et al. Topical corticosteroids in dermatology. JDD 2009; 8: 1093-105.
55. Elmariah SB. Adjunctive Management of Itch in Atopic Dermatitis. Dermatol. Clin. 2017; 35: 373-94.
56. Vieira BL, Lim NR, Lohman ME et al. Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review. Am. J. Clin. Dermatol. 2016; 17: 557-81.