The research presented by Ruge et al. 1 sheds light on the potential use of palmar hyperlinearity combined with type 2 inflammation skin biomarkers as early predictive markers of atopic dermatitis (AD) in infants. Palmar hyperlinearity is a phenotypic expression of mutations in the filaggrin gene (FLG) and is primarily associated with ichthyosis vulgaris. 1 Previous studies have shown that 74.5% of children with FLG null mutations exhibit palmar hyperlinearity. 2 However, it is also known as one of the minor diagnostic criteria for AD. 3 By reading the palms and integrating this clinical phenotype with the analysis of type 2 inflammatory skin biomarkers, the authors take a more comprehensive approach to predicting AD early on. They found that alterations in these type 2 biomarkers could be detected several months prior to the clinical onset of AD. Moreover, the study shows that infants with hyperlinear palms at 2 months of age were more likely to develop AD within the first year of life compared to infants without hyperlinear palms, even when adjusted for FLG mutation status. This likelihood increased further with elevated TARC/CCL17 levels at 2 months of age. These findings suggest an interaction between skin barrier dysfunction and early immune dysregulation.
Few studies have focused on using skin tape strips to predict AD onset in infants. Berdyshev et al. 4 found that non‐invasive skin tape stripping at 2 months of age can identify asymptomatic children at risk of AD development with high probability. Skin tape stripping has several advantages, mainly due to its non‐invasive character. Moreover, van der Rijst et al. 5 showed the complementary roles of tape strips and serum in profiling immune and epidermal barrier proteins in paediatric AD patients treated with dupilumab, highlighting the utility of skin tape stripping for monitoring proteomic responses during treatment.
Furthermore, the early recognition of infants at risk for AD is of particular interest given its role in the atopic march. The atopic march refers to the sequential development of allergic diseases, including food allergies, allergic asthma and allergic rhinitis. Palmar hyperlinearity in early childhood AD has been associated with FLG mutations and sensitization to egg, further supporting its role in the atopic march. 3 Therefore, combining clinical phenotypes with molecular biomarker analysis may allow for the early identification of high‐risk infants and may create opportunities for timely preventive intervention. This could potentially reduce disease severity and limit progression to other allergic manifestations.
However, there is currently no standardized measure to objectify palmar hyperlinearity, and therefore, it may be susceptible to subjective interpretation. Furthermore, skin biomarker analysis may not be widely available, and the associated costs can be a limiting factor, making the broader application limited. Additionally, a strong family predisposition to atopic diseases was prevalent in the study population, which may have contributed to the high incidence of AD and could have influenced the outcome of this study. Interestingly, slightly higher EASI scores were observed among infants without hyperlinear palms, suggesting that hyperlinearity may not directly correlate with disease severity. 1
In summary, Ruge et al. reinvent themselves as modern palmists and provide compelling evidence integrating clinical phenotypes, such as palmar hyperlinearity, with skin tape strip‐derived biomarkers, offering a promising, non‐invasive strategy for early AD prediction. This approach highlights the importance of the skin barrier and early immune dysregulation in AD pathogenesis and may lead to preventive interventions that may alter the progression of the atopic march.
CONFLICT OF INTEREST STATEMENT
F. Vroman has been a speaker for Sanofi, and M. de Graaf has been a consultant, advisory board member and/or speaker for AbbVie, ALK, Almirall, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals and Sanofi.
Vroman F, de Graaf M. Reading the palms: Palmar hyperlinearity and type 2 biomarkers as early predictors of atopic dermatitis onset in infancy? J Eur Acad Dermatol Venereol. 2025;39:2028–2029. 10.1111/jdv.70113
Linked Article: I. F. Ruge et al. J Eur Acad Dermatol Venereol 2025;39:2079–2087. https://doi.org/10.1111/jdv.20824.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analysed in this study.
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Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analysed in this study.