Age-related immunosenescence and total serum IGE dynamics in geriatric dermatomycoses

Superficial fungal infections diagnosed in elderly individuals commonly become chronic and respond poorly to treatment, resulting in suboptimal clinical treatment outcomes. Age-related immune senescence is characterized by weakened cell-mediated immunity with particular emphasis on the Th1 and Th17 pathways which play an essential role in the host’s response to fungal infections. Nonetheless, the correlation between thetotal serum immunoglobulin E (IgE) levels and the superficial fungal infections in the cases of non-atopic geriatric patients remains inadequately characterized. This study aimed to compare the total serum IgE concentrations between older and younger patients diagnosed with superficial fungal infections.A total of twenty-five non-atopic patients with confirmed superficial fungal infections through microbiological techniques involving fungal culture and potassium hydroxide microscopy (KOH) were categorized in two groups: Group 1 consisted of 13 older patients (≥65 years, n = 13) whilst Group 2 included 12 younger patients within the ages of 18-45 years old. Through the usage of chemiluminescent immunoassay (CLIA), total serum IgE concentrations of all the patients were determined with values below 100IU/mL being considered normal. It should be noted that entities with allergic rhinitis, eczema or parasitic infections were not included in the study, to minimize the confounding factors which might affect IgE levels.In the geriatric group with a percentage of 69.2, 9 out of 13 patients presented with elevated serum IgE levels (>100IU/mL) as opposed to a 25.0 percentage with 3 out of 12 patients in the younger cohort (p = 0.047). Furthermore, in the elderly cohort, mean serum IgE concentrations were markedly higher than in the younger cohort with the following statistics for group 1; 462.8 ± 105.4 IU/mL, and Group 2 135.2 ± 38.6 IU/mL; p< 0.001. A longer disease duration was noted in Group 1 patients as well (3.1 years vs 0.5 years). in 72.0% of the cases in both groups, the predominant etiological organism was Trichophyton rubrum. Moreover, a strong association was identified between serum IgE concentrations and increasing age(p = 0.001, r = 0.612).The age-related deterioration in cell-mediated antifungal immunity may promote a Th2-biased immune response, resulting in an increase serum IgE concentration in patients, independent of atopic disease. Thisimmunological response presents a great shift which may play a role to chronicity as well as persistence of superficial fungal infections in older adults. Therefore, the assessment of baseline serum IgE measurement provides a great and valuable adjunctive biomarker for labeling older adult patients who are more likely to benefit from prolonged as well as intensified antifungal treatment.
Keywords: Dermatomycoses, Total Serum IgE, Immunosenescence, Geriatric Dermatology, Trichophyton rubrum