Properties of Candida Albicans: Mycogenic Sensitization as a Trigger of Atopic Dermatitis and Psoriasis Vulgaris

Properties of Candida Albicans: Mycogenic Sensitization as a Trigger of Atopic Dermatitis and Psoriasis Vulgaris | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Properties of Candida Albicans: Mycogenic Sensitization as a Trigger of Atopic Dermatitis and Psoriasis Vulgaris Esionova E.V., Mavlyanova Sh.Z, Izvekova O.V, Alimukhamedova Yu.A.,, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7641034/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Candida spp. are common opportunistic microorganisms in the human body. The most prevalent and highly pathogenic species in the mycobiome is Candida albicans, which induces mycogenic sensitization Objective: This study aimed to determine mycogenic sensitization to Candida albicans in patients with atopic dermatitis (AD) and psoriasis vulgaris (PV) living in Uzbekistan. Materials and methods: We enrolled 75 patients with AD aged 18 to 67 years and 69 patients with PV aged 23 to 72 years. Mycological examination of intestinal samples (culture on Sabouraud medium) was performed in all patients. Total IgE levels were measured using CLIA, and IgG Candida albicans was determined by ELISA. In AD patients, the POEM index was assessed, while in PV patients the PASI score was evaluated as well. Results: Intestinal proliferation of Candida spp. exceeding 10³ CFU/ml was detected in 61% AD patients (58/75) and 45% PV patients (31/69). Species identification revealed a predominance of Candida albicans in 85% of AD cases and 77% of PV cases. In the control group, Candida spp. were detected in 36.6% (11/30); all isolates were identified as Candida albicans . In AD patients with intestinal candidiasis caused by Candida albicans , the total IgE level was 232.8 ± 13.9 IU/mL, in AD patients without intestinal candidiasis – 136 ± 9 IU/mL, and in the control group – 90 ±5.5 IU/mL (p<0.001). The mean IgG Candida albicans in AD patients with intestinal candidiasis was 0.706 ± 0.16 ng/mL, in AD patients without intestinal candidiasis – 0.428±0.07 ng/mL, healthy individuals 0.303 ± 0.09 (p<0.001). In PV patients with intestinal candidiasis caused by Candida albicans , the total IgE level was 131 ± 9.3 IU/mL, in PV patients without intestinal candidiasis – 121.4 ± 13.2 IU/mL, and in the control group – 90 ± 5.5 IU/mL (p<0.001). The mean IgG Candida albicans in PV patients with intestinal candidiasis was higher than in the control group (0.562 ± 0.3 ng/mL vs 0.303 ± 0.09; p0.05). In AD patients complicated by mycogenic sensitization, the POEM was 21.5 ± 2.3 points, whereas in AD patients without mycogenic sensitization, the index was 12.2 ± 2.8 points. In PV patients complicated by mycogenic sensitization, the PASI was 20.7 ± 2.46 points, while in those without mycogenic sensitization, the PASI was 11.4 ± 2.26 points. Conclusion: Mycogenic sensitization was detected in 61% AD cases and 45% PV cases, accompanied by intestinal candidiasis and elevated levels of total IgE and IgG Candida albicans . The skin manifestations of AD and PV complicated by mycogenic sensitization were characterized as severe, according to the POEM and PASI indices. Dermatology atopic dermatitis psoriasis vulgaris mycogenic sensitization Candida spp. Candida albicans РОЕМ SCORAD Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The deteriorating environmental situation and scientific–technological progress have led to changes in the interaction between humans and microorganisms [1]. The increase in the number of opportunistic representatives of the proliferative genus Candida has allowed them to become ubiquitous “cosmopolitans” of the 21st century [2]. During evolution, Candida spp . developed adaptive mechanisms that made them a progressive group of microorganisms [3]. Among the fungi of this genus, one of the most extensively studied human commensals and representatives of the mycobiome is Candida albicans [4]. The shift from commensalism to opportunistic parasitism occurs when components of the host immune system are suppressed [5]. An inadequate immune response to Candida albicans allergens may lead to mycogenic sensitization, which aggravates the clinical course, reduces therapeutic efficacy, increases the frequency of relapses of the underlying disease, and decreases patients’ quality of life. In this study, we aimed to determine mycogenic sensitization to Candida albicans in patients with atopic dermatitis (AD) and psoriasis vulgaris (PV) living in the Republic of Uzbekistan. MATERIALS AND METHODS: Study design The study was designed as a descriptive cross-sectional study. The study was conducted among patients of the Dermatology Department at the Republican Specialized Scientific and Practical Medical Center of Dermatovenereology and Cosmetology between January and July in 2025. A total of 75 AD patients, aged 18–67 years, and 69 PV patients, aged 23–72 years, were enrolled. Among AD patients, there were 32 men (42.6%) and 43 women (57.4%), while among PV patients, there were 33 men (47.8%) and 36 women (52.2%). Females predominated in the AD group (65% of cases) and in the PV group (52% of cases). The control group included 30 individuals matched for sex and age. All patients presented with active manifestations of the disease and had a verified diagnosis of AD and PV according to ICD-10 codes L20 and L40.0, respectively. Inclusion criteria : age over 18 years; verified diagnoses according to ICD-10. Exclusion criteria : age under 18 years; pregnancy; lactation; history of opportunistic infections. Mycological examination Intestinal samples were cultured on Sabouraud agar, followed by incubation for 72 hours. For the identification of Candida spp . colonies, chromogenic agar HiCrome (India) was used. Colonies grown on Sabouraud medium were subcultured onto HiCrome and incubated at 35 °C for 48 hours. Species identification was performed according to the manufacturer’s recommendations: Candida albicans produced smooth green colonies; Candida krusei —diffuse purple colonies; Candida tropicalis —blue or metallic-blue convex colonies. Chemiluminescent Immunoassay (CLIA) The determination of total IgE was performed by CLIA using an automated analyzer (AutoLumo, A1860, Autobio, China) with a certified reagent kit (Autobio, China). Venous blood samples were collected in the fasting state, and serum was separated by centrifugation at 3000 rpm for 10 minutes. Results were expressed in IU/mL. Reference values: up to 100 IU/mL. Enzyme-Linked Immunosorbent Assay (ELISA) The determination of IgG antibodies to Candida albicans was carried out using a diagnostic kit “Cytokin” (Vector-Best, Russia) in accordance with the manufacturer’s instructions. The test material was venous blood serum, separated by centrifugation at 3000 rpm for 10 minutes. The reaction was performed in microplate wells pre-coated with Candida albicans antigen. After incubation with the sample, a horseradish peroxidase–conjugated antibody was added, followed by a substrate–chromogen system (TMB). Optical density was measured with a spectrophotometer at 450 nm, using 620–630 nm as the reference wavelength. All analyses were performed in the laboratory of mycology and serology of the center. In patients with AD, the POEM index recommended by HOME (Harmonising Outcome Measures for Eczema) was assessed, while in PV patients the PASI index was evaluated using the FotoFinder ATBM bodystudio device with artificial intelligence. The study was conducted in accordance with the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from all participants prior to enrollment. Statistical analysis For statistical analysis, ANOVA test was used to measure variations of the results among patients with AD, PV, and the control group. Post hoc comparisons were conducted using Tukey test. Data are presented as mean ± standard deviation (SD). A significance level of p<0.05 was considered statistically significant. Graphs were generated using OriginPro 8.6. RESULTS We establish in the article that patients living in the Republic of Uzbekistan with certain skin diseases (AD and PV) often exhibit mycogenic sensitization to Candida albicans , which aggravates the course of the underlying disease. In the intestines, proliferation of yeast-like fungi of the genus Candida exceeding 10³ CFU/mL was recorded in 61% (46/75) of AD patients, whereas in PV patients it was observed in 45% (31/69). These patients were diagnosed with “intestinal candidiasis.” Species identification in AD patients showed a predominance of Candida albicans at 84% (39 patients), Candida krusei at 11% (5 patients), and Candida tropicalis at 5% (2 patients). Among PV patients, Candida albicans also predominated at 78% (24 patients), while Candida krusei and Candida tropicalis accounted for 16% (5 patients) and 6% (2 patients), respectively. Considering the limited data on non-albicans species, they were not included in further analysis. In the control group, Candida spp. was detected in 36% (11/30) of individuals, and species identification showed that all isolates belonged to Candida albicans . Table 1. Table 1. Distribution of Candida spp. in atopic dermatitis, vulgar psoriasis and healthy controls Species AD (n=75) VP (n=69) Heathy control (n=30) Candida spp. Total 46 (61%) 31 (45%) 11 (36%) Candida albicans 39 (85%) 24 (77%) 11 (100%) Candida krusei 5 (11%) 2 (7%) - Candida tropicalis 2 (4%) 5 (16%) - non-Candida - 29 (39%) 38 (55%) 19 (64%) Intestine distribution of Candida ssp . in atopic dermatitis, vulgar psoriasis and healthy controls is shown in this table. Intestinal Candida findings in AD patients higher than in PV ones (61% vs 45%). In patients from both AD groups, the mean total IgE level was higher than in the control group (p<0.001). In AD patients with intestinal candidiasis caused by Candida albicans , the total IgE level was 232.8 ± 13.9 IU/mL, which was 2.6 times higher than in the control group (90 ± 5.5 IU/mL; p<0.001) and 1.7 times higher than in AD patients without intestinal candidiasis (136 ± 9 IU/mL; p<0.001). A similar trend was observed for IgG Candida albicans : in AD patients with intestinal candidiasis, the mean IgG level was 2.3 times higher than in the control group (0.706 ± 0.16 ng/mL vs. 0.303 ± 0.09 ng/mL; p<0.001), and 1.4 times higher than in AD patients without intestinal candidiasis (0.428 ± 0.07 ng/mL; p<0.05). These values were also significantly higher compared to healthy individuals. Figure 1 (a,b). In patients from both PV groups, the mean total IgE level was higher than in the control group (p<0.001; p<0.01). In PV patients with intestinal candidiasis caused by Candida albicans , the total IgE level was 131 ± 9.3 IU/mL, which was 1.5 times higher than in the control group (90 IU/mL; p<0.001) and 1.1 times higher than in PV patients without intestinal candidiasis (121.4 ± 13.2 IU/mL; p<0.001). In PV patients with intestinal candidiasis caused by Candida albicans , IgG to Candida albicans was elevated compared to healthy individuals (p0.05). The mean IgG to Candida albicans in PV patients with intestinal candidiasis was 1.8 times higher than in the control group (0.562 ± 0.3 ng/mL vs. 0.303 ± 0.09 ng/mL; p0.05). Figure 2 (a,b). In AD patients with mycogenic sensitization to Candida albicans , the SCORAD index was 21.5 ± 2.3 points, corresponding to a severe disease course, whereas in AD patients without mycogenic sensitization, the index corresponded to a moderate disease course (12.2 ± 2.8 points). Figure 3. In PV patients with mycogenic sensitization to Candida albicans , the PASI score was 20.7 ± 2.46 points, indicating severe psoriasis, whereas in patients without mycogenic sensitization, the PASI score was 11.4 ± 2.26 points, corresponding to a moderate disease course. Figure 4. DISCUSSION In our study, we investigated intestinal colonization by Candida species and mycogenic sensitization to Candida albicans —the predominant agent of intestinal candidiasis—in AD and PV patients living in Uzbekistan. It is known that dysregulation of the human immune system leads to disruption of the symbiosis with opportunistic Candida spp ., causing their proliferative activity in various biological substrates [ 6 , 7 ]. According to [ 8 ], the “primary site” of Candida spp . colonization in the human body is the intestine: Candida albicans is found in 50%–54% of the small intestine, 55%–70% of the large intestine, and 65%–70% of feces. We also selected intestinal secretions as the object for detecting Candida spp . In our study, intestinal candidiasis was observed in 61% of AD patients and 45% of PV patients. In studies [ 9 ], Candida spp . were detected in the feces of patients with psoriasis in 60.8% of cases, which is significantly higher than our finding. According to other studies [ 10 ], Candida spp . colonization in feces was 13%. This variation can be explained by ethnic characteristics, national dietary preferences (high consumption of fermented dairy products and alcohol), and the environmental conditions of different countries. In all studies focused on species identification of yeast-like Candida fungi in intestinal samples from patients with psoriasis, increased proliferation of Candida albicans was reported, ranging from 41.5% to 100% of cases [ 9 , 10 ]. This was also confirmed in our study, with a prevalence of 77%. In AD patients, colonization of Candida spp . in intestinal samples was higher than in VP patients. This phenomenon suggests a disruption of the local mucosal immune system in AD patients, which increases fungal adhesion [ 11 ]. Additionally, functional disorders of gastrointestinal motility lead to changes in the metabolic activity of the intestinal microbiota [ 12 ]. Study [ 13 ] reported intestinal candidiasis in 30.9% of AD patients, with a predominance of Candida albicans . In article [ 14 ], intestinal candidiasis was observed in all AD patients, who also exhibited dyspeptic disorders. In our study, Candida spp. proliferation was observed in 61% of AD patients, with marked Candida albicans colonization in 85% of cases. The interaction of the intestinal mycobiome with the immune system ensures the body’s homeostasis. Quantitative and qualitative changes in intestinal content are among the triggers of AD and PV. We believe that identifying disease-associated mycobiomes requires a thorough study of population characteristics, geographical features, culinary traditions (such as high consumption of fermented dairy products in the Uzbek region), harmful habits typical for the given population (for example, the use of naswar in the Uzbek population), as well as the adaptive properties of Candida spp. under different population conditions. The pathogenicity of Candida albicans is explained by its exceptional metabolic adaptability, its ability to switch between yeast and hyphal forms [ 15 ], and the production of a peptide toxin that activates the cytokine cascade [ 16 ]. Excessive growth of Candida albicans in the intestine can lead to mycogenic sensitization, which in turn aggravates the course of the underlying disease [ 14 , 17 ]. Isolated studies on mycogenic sensitization have been conducted worldwide; however, the detection rates varied [ 17 , 18 ]. To date, there is no established algorithm for diagnosing mycogenic sensitization due to the wide spectrum of saprophytic fungal infections. In our study, we detected high levels of Candida albicans in intestinal samples both in patients with allergic disease – AD and in patients with an autoimmune disease – PV. The main criterion for mycogenic sensitization is the detection of specific immunoglobulin E to fungal agents, although in healthy individuals living in regions with high fungal exposure, these indicators may be positive even in the absence of clinical manifestations. Therefore, for the first time, we proposed biological markers for identifying mycogenic sensitization to Candida albicans, the most common mycoallergen: total IgE over 200 IU/mL and IgG Candida albicans above 0.3 ng/mL. We observed a statistically significant increase in IgE and IgG Candida albicans in AD patients with mycogenic sensitization, which supports our hypothesis of using these parameters as criteria for mycogenic sensitization. Additionally, the POEM score in this patient group was significantly higher compared to patients without mycogenic sensitization. In our study, we observed a non-significant increase in IgG Candida albicans in PV patients without intestinal candidiasis compared to PV patients with Candida albicans -induced candidiasis, which may be explained by the immunological mechanisms underlying psoriasis. In psoriasis, there is a shift toward Th1-lymphocytes with hyperproduction of IL-17 and IL-23, which provide antifungal immunity; therefore, we did not observe significant differences between patients with and without mycogenic sensitization [ 19 ]. At the same time, the PASI score showed a significant difference between these two groups. We also did not observe a significant increase in IgG Candida albicans in PV patients without intestinal candidiasis compared to healthy individuals. This may be explained by the fact that patients with psoriasis have less pronounced disruption of the skin and mucosal barriers than AD patients, and therefore do not exhibit significant Candida colonization. These findings warrant multicenter studies with larger patient cohorts. In our study conducted in Uzbekistan, mycogenic sensitization was detected in 61% of AD patients and 45% of PV patients. In our opinion, comprehensive detection of mycogenic sensitization should be included among routine methods in dermatological research. CONCLUSION 1. Mycogenic sensitization was observed in 61% of AD cases and 45% of VP cases, with patients exhibiting confirmed intestinal candidiasis and elevated levels of total IgE and IgG Candida albicans. 2. Patients with mycogenic sensitization had a severe course of AD and VP, as indicated by the POEM and PASI scores. 3. These findings highlight the need for routine diagnosis of mycogenic sensitization to Candida albicans in patients with skin diseases to optimize therapy. LIMITATIONS There are some limitations that may have influenced the statistical ratios in our study. i. Considering the short duration of the study, the patient cohort, although representative, was not large enough to increase the statistical power regarding the prevalence of Candida spp. ii. Limited data on the detection of Candida tropicalis and Candida krusei in patients hindered obtaining comprehensive information about the distribution of non-Candida albicans species and their potential clinical significance. Nevertheless, our findings confirmed the predominance of Candida albicans as the main allergenic species responsible for mycogenic sensitization. Declarations The study was approved by the Ethics Committee of the Republican specialized scientific and practical medical center of dermatovenerology and cosmetology, Tashkent, Uzbekistan. CONFLICT OF INTEREST The authors have nothing to disclose References Crameri R, Garbani M, Rhyner C, Huitema C. Fungi: The neglected allergenic sources. Allergy . 2014;69(2):176–185. doi:10.1111/all.12325. Zverev VV, Boichenko MN, Bykov AS, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7641034","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516577652,"identity":"b0743c09-e624-4c50-bc34-f05b5b794803","order_by":0,"name":"Esionova 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07:54:30","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79550,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/fca5c6c839b0e4709ee7f964.html"},{"id":91962197,"identity":"f6c46e4c-d776-4692-9723-a0191ff61c4f","added_by":"auto","created_at":"2025-09-23 07:54:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":167459,"visible":true,"origin":"","legend":"\u003cp\u003e(a,b). Finding total IgE and IgG Candida albicans in atopic dermatitis patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans, \u003c/em\u003eatopic dermatitis patients without candidiasis, and healthy control group.\u003c/p\u003e\n\u003cp\u003eIn patients from both AD groups, the mean total IgE level was statistically significant than in the control group (p\u0026lt;0.001). The highest level of total IgE was in patients with intestinal candidiasis caused by Candida albicans (232.8 ± 13.9 IU/mL). In patients from both AD groups, the mean IgG \u003cem\u003eCandida albicans\u003c/em\u003e was statistically significant than in the control group (p\u0026lt;0.001; p\u0026lt;0.05). The highest level of IgG Candida albicans was in patients with intestinal candidiasis caused by Candida albicans (0.706 ± 0.16 ng/mL).\u003c/p\u003e\n\u003cp\u003eThe data represent the mean ± standard deviation of three groups (ANOVA, Turkey).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/81d651b3b40970d36620e5b3.png"},{"id":91962178,"identity":"7ee31fa2-816e-4c2c-bb58-dd04f32fb239","added_by":"auto","created_at":"2025-09-23 07:54:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":211494,"visible":true,"origin":"","legend":"\u003cp\u003e(a,b). Finding total IgE and IgG Candida albicans in psoriasis vulgaris patients with intestinal candidiasis caused by Candida albicans, psoriasis vulgaris patients without candidiasis, and healthy control group.\u003c/p\u003e\n\u003cp\u003eIn patients from both psoriasis vulgaris groups, the mean total IgE level was statistically significant than in the control group (p\u0026lt;0.001, p\u0026lt;0.01). The highest level of total IgE was in patients with intestinal candidiasis caused by Candida albicans (121.4 ± 13.2 IU/mL). In patients only from AD with intestinal candidiasis caused by Candida albicans, the mean IgG Candida albicans was statistically significant than in the control group (p\u0026lt;0.05). The highest level of IgG Candida albicans was in patients with intestinal candidiasis caused by Candida albicans (0.562 ± 0.3 ng/mL).\u003c/p\u003e\n\u003cp\u003eThe data represent the mean ± standard deviation of three groups (ANOVA, Turkey).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/1e71637d8671ff3eacf8a490.png"},{"id":91962198,"identity":"0acf5465-208a-46d9-8bd5-e4315c1a0b4a","added_by":"auto","created_at":"2025-09-23 07:54:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":90185,"visible":true,"origin":"","legend":"\u003cp\u003ePOEM index in atopic dermatitis patients with mycological sensitization to \u003cem\u003eCandida albicans \u003c/em\u003eand atopic dermatitis patients without sensitization.\u003c/p\u003e\n\u003cp\u003ePOEM index was significant in AD patients without mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e than AD patients without mycogenic sensitization (21.5 ± 2.3 vs 12.2 ± 2.8 points, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe data represent the mean ± standard deviation of two groups (ANOVA, Turkey).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/ae50484305fdbf4ac1c4f53f.png"},{"id":91962194,"identity":"c76d0ba9-1106-44a4-b64a-c3a5ddf728f5","added_by":"auto","created_at":"2025-09-23 07:54:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":125435,"visible":true,"origin":"","legend":"\u003cp\u003ePASI index in psoriasis vulgar patients with mycological sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e and psoriasis vulgar patients without sensitization.\u003c/p\u003e\n\u003cp\u003ePASI index was significant in psoriasis vulgaris patients without mycogenic sensitization to Candida albicans than psoriasis vulgaris patients without mycogenic sensitization (20.7 ± 2.46 vs 11.4 ± 2.26 points, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe data represent the mean ± standard deviation of two groups (ANOVA, Turkey).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/ff6ec791d18ec2bfeb50b534.png"},{"id":91963290,"identity":"cfa9899d-a65b-4f61-a223-e146dda3f894","added_by":"auto","created_at":"2025-09-23 08:02:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1023430,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7641034/v1/40de85bb-aaf2-467d-93be-e3a4d9ca85da.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eProperties of Candida Albicans: Mycogenic Sensitization as a Trigger of Atopic Dermatitis and Psoriasis Vulgaris\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe deteriorating environmental situation and scientific\u0026ndash;technological progress have led to changes in the interaction between humans and microorganisms [1]. The increase in the number of opportunistic representatives of the proliferative genus \u003cem\u003eCandida\u0026nbsp;\u003c/em\u003ehas allowed them to become ubiquitous \u0026ldquo;cosmopolitans\u0026rdquo; of the 21st century [2]. During evolution, \u003cem\u003eCandida spp\u003c/em\u003e. developed adaptive mechanisms that made them a progressive group of microorganisms [3]. Among the fungi of this genus, one of the most extensively studied human commensals and representatives of the mycobiome is \u003cem\u003eCandida albicans\u003c/em\u003e [4]. The shift from commensalism to opportunistic parasitism occurs when components of the host immune system are suppressed [5]. An inadequate immune response to \u003cem\u003eCandida albicans\u003c/em\u003e allergens may lead to mycogenic sensitization, which aggravates the clinical course, reduces therapeutic efficacy, increases the frequency of relapses of the underlying disease, and decreases patients\u0026rsquo; quality of life.\u003c/p\u003e\n\u003cp\u003eIn this study, we aimed to determine mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e in patients with atopic dermatitis (AD) and psoriasis vulgaris (PV) living in the Republic of Uzbekistan.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS:","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was designed as a descriptive cross-sectional study.\u003c/p\u003e\n\u003cp\u003eThe study was conducted among patients of the Dermatology Department at the Republican Specialized Scientific and Practical Medical Center of Dermatovenereology and Cosmetology between January and July in 2025. A total of 75 AD patients, aged 18\u0026ndash;67 years, and 69 PV patients, aged 23\u0026ndash;72 years, were enrolled. Among AD patients, there were 32 men (42.6%) and 43 women (57.4%), while among PV patients, there were 33 men (47.8%) and 36 women (52.2%). Females predominated in the AD group (65% of cases) and in the PV group (52% of cases). The control group included 30 individuals matched for sex and age. All patients presented with active manifestations of the disease and had a verified diagnosis of AD and PV according to ICD-10 codes L20 and L40.0, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/strong\u003e: age over 18 years; verified diagnoses according to ICD-10.\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eExclusion criteria\u003c/em\u003e\u003c/strong\u003e: age under 18 years; pregnancy; lactation; history of opportunistic infections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMycological examination\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntestinal samples were cultured on Sabouraud agar, followed by incubation for 72 hours. For the identification of \u003cem\u003eCandida spp\u003c/em\u003e. colonies, chromogenic agar \u003cem\u003eHiCrome\u003c/em\u003e (India) was used. Colonies grown on Sabouraud medium were subcultured onto \u003cem\u003eHiCrome\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eand incubated at 35 \u0026deg;C for 48 hours. Species identification was performed according to the manufacturer\u0026rsquo;s recommendations: \u003cem\u003eCandida albicans\u003c/em\u003e produced smooth green colonies; \u003cem\u003eCandida krusei\u003c/em\u003e\u0026mdash;diffuse purple colonies; \u003cem\u003eCandida tropicalis\u003c/em\u003e\u0026mdash;blue or metallic-blue convex colonies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eChemiluminescent Immunoassay (CLIA)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe determination of total IgE was performed by CLIA using an automated analyzer (AutoLumo, A1860, Autobio, China) with a certified reagent kit (Autobio, China). Venous blood samples were collected in the fasting state, and serum was separated by centrifugation at 3000 rpm for 10 minutes. Results were expressed in IU/mL. Reference values: up to 100 IU/mL.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEnzyme-Linked Immunosorbent Assay (ELISA)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe determination of IgG antibodies to \u003cem\u003eCandida albicans\u003c/em\u003e was carried out using a diagnostic kit \u0026ldquo;Cytokin\u0026rdquo; (Vector-Best, Russia) in accordance with the manufacturer\u0026rsquo;s instructions. The test material was venous blood serum, separated by centrifugation at 3000 rpm for 10 minutes. The reaction was performed in microplate wells pre-coated with \u003cem\u003eCandida albicans\u003c/em\u003e antigen. After incubation with the sample, a horseradish peroxidase\u0026ndash;conjugated antibody was added, followed by a substrate\u0026ndash;chromogen system (TMB). Optical density was measured with a spectrophotometer at 450 nm, using 620\u0026ndash;630 nm as the reference wavelength.\u003c/p\u003e\n\u003cp\u003eAll analyses were performed in the laboratory of mycology and serology of the center.\u003c/p\u003e\n\u003cp\u003eIn patients with AD, the POEM index recommended by HOME (Harmonising Outcome Measures for Eczema) was assessed, while in PV patients the PASI index was evaluated using the FotoFinder ATBM bodystudio device with artificial intelligence.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from all participants prior to enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor statistical analysis, ANOVA test was used to measure variations of the results among patients with AD, PV, and the control group. Post hoc comparisons were conducted using Tukey test. Data are presented as mean \u0026plusmn; standard deviation (SD). A significance level of p\u0026lt;0.05 was considered statistically significant. Graphs were generated using OriginPro 8.6.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe establish in the article that patients living in the Republic of Uzbekistan with certain skin diseases (AD and PV) often exhibit mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e, which aggravates the course of the underlying disease.\u003c/p\u003e\n\u003cp\u003eIn the intestines, proliferation of yeast-like fungi of the genus Candida exceeding 10\u0026sup3; CFU/mL was recorded in 61% (46/75) of AD patients, whereas in PV patients it was observed in 45% (31/69). These patients were diagnosed with \u0026ldquo;intestinal candidiasis.\u0026rdquo; Species identification in AD patients showed a predominance of \u003cem\u003eCandida albicans\u003c/em\u003e at 84% (39 patients), \u003cem\u003eCandida krusei\u003c/em\u003e at 11% (5 patients), and \u003cem\u003eCandida tropicalis\u003c/em\u003e at 5% (2 patients). Among PV patients, \u003cem\u003eCandida albicans\u003c/em\u003e also predominated at 78% (24 patients), while \u003cem\u003eCandida krusei\u003c/em\u003e and \u003cem\u003eCandida tropicalis\u003c/em\u003e accounted for 16% (5 patients) and 6% (2 patients), respectively.\u003c/p\u003e\n\u003cp\u003eConsidering the limited data on non-albicans species, they were not included in further analysis. In the control group, \u003cem\u003eCandida spp.\u003c/em\u003e was detected in 36% (11/30) of individuals, and species identification showed that all isolates belonged to \u003cem\u003eCandida albicans\u003c/em\u003e. Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Distribution of Candida spp. in atopic dermatitis, vulgar psoriasis and healthy controls\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=69)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeathy control\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCandida spp.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e46 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e31 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eCandida albicans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e39 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e24 (77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eCandida krusei\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003eCandida tropicalis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003enon-Candida\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e29 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e38 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e19 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIntestine distribution of \u003cem\u003eCandida ssp\u003c/em\u003e. in atopic dermatitis, vulgar psoriasis and healthy controls is shown in this table. Intestinal \u003cem\u003eCandida\u003c/em\u003e findings in AD patients higher than in PV ones (61% vs 45%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn patients from both AD groups, the mean total IgE level was higher than in the control group (p\u0026lt;0.001). In AD patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans\u003c/em\u003e, the total IgE level was 232.8 \u0026plusmn; 13.9 IU/mL, which was 2.6 times higher than in the control group (90 \u0026plusmn; 5.5 IU/mL; p\u0026lt;0.001) and 1.7 times higher than in AD patients without intestinal candidiasis (136 \u0026plusmn; 9 IU/mL; p\u0026lt;0.001). A similar trend was observed for IgG \u003cem\u003eCandida albicans\u003c/em\u003e: in AD patients with intestinal candidiasis, the mean IgG level was 2.3 times higher than in the control group (0.706 \u0026plusmn; 0.16 ng/mL vs. 0.303 \u0026plusmn; 0.09 ng/mL; p\u0026lt;0.001), and 1.4 times higher than in AD patients without intestinal candidiasis (0.428 \u0026plusmn; 0.07 ng/mL; p\u0026lt;0.05). These values were also significantly higher compared to healthy individuals. Figure 1 (a,b).\u003c/p\u003e\n\u003cp\u003eIn patients from both PV groups, the mean total IgE level was higher than in the control group (p\u0026lt;0.001; p\u0026lt;0.01). In PV patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans\u003c/em\u003e, the total IgE level was 131 \u0026plusmn; 9.3 IU/mL, which was 1.5 times higher than in the control group (90 IU/mL; p\u0026lt;0.001) and 1.1 times higher than in PV patients without intestinal candidiasis (121.4 \u0026plusmn; 13.2 IU/mL; p\u0026lt;0.001). In PV patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans\u003c/em\u003e, IgG to \u003cem\u003eCandida albicans\u003c/em\u003e was elevated compared to healthy individuals (p\u0026lt;0.05), whereas in PV patients without intestinal candidiasis, the increase was not significant (p\u0026gt;0.05). The mean IgG to \u003cem\u003eCandida albicans\u003c/em\u003e in PV patients with intestinal candidiasis was 1.8 times higher than in the control group (0.562 \u0026plusmn; 0.3 ng/mL vs. 0.303 \u0026plusmn; 0.09 ng/mL; p\u0026lt;0.001), and 1.4 times higher than in PV patients without intestinal candidiasis, reaching 0.438 \u0026plusmn; 0.18 ng/mL (p\u0026gt;0.05). Figure 2 (a,b).\u003c/p\u003e\n\u003cp\u003eIn AD patients with mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e, the SCORAD index was 21.5 \u0026plusmn; 2.3 points, corresponding to a severe disease course, whereas in AD patients without mycogenic sensitization, the index corresponded to a moderate disease course (12.2 \u0026plusmn; 2.8 points). Figure 3.\u003c/p\u003e\n\u003cp\u003eIn PV patients with mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e, the PASI score was 20.7 \u0026plusmn; 2.46 points, indicating severe psoriasis, whereas in patients without mycogenic sensitization, the PASI score was 11.4 \u0026plusmn; 2.26 points, corresponding to a moderate disease course. Figure 4.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn our study, we investigated intestinal colonization by \u003cem\u003eCandida species\u003c/em\u003e and mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e\u0026mdash;the predominant agent of intestinal candidiasis\u0026mdash;in AD and PV patients living in Uzbekistan. It is known that dysregulation of the human immune system leads to disruption of the symbiosis with opportunistic \u003cem\u003eCandida spp\u003c/em\u003e., causing their proliferative activity in various biological substrates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the \u0026ldquo;primary site\u0026rdquo; of \u003cem\u003eCandida spp\u003c/em\u003e. colonization in the human body is the intestine: \u003cem\u003eCandida albicans\u003c/em\u003e is found in 50%\u0026ndash;54% of the small intestine, 55%\u0026ndash;70% of the large intestine, and 65%\u0026ndash;70% of feces. We also selected intestinal secretions as the object for detecting \u003cem\u003eCandida spp\u003c/em\u003e. In our study, intestinal candidiasis was observed in 61% of AD patients and 45% of PV patients.\u003c/p\u003e\u003cp\u003eIn studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], \u003cem\u003eCandida spp\u003c/em\u003e. were detected in the feces of patients with psoriasis in 60.8% of cases, which is significantly higher than our finding. According to other studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], \u003cem\u003eCandida spp\u003c/em\u003e. colonization in feces was 13%. This variation can be explained by ethnic characteristics, national dietary preferences (high consumption of fermented dairy products and alcohol), and the environmental conditions of different countries.\u003c/p\u003e\u003cp\u003eIn all studies focused on species identification of yeast-like \u003cem\u003eCandida\u003c/em\u003e fungi in intestinal samples from patients with psoriasis, increased proliferation of Candida albicans was reported, ranging from 41.5% to 100% of cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This was also confirmed in our study, with a prevalence of 77%.\u003c/p\u003e\u003cp\u003eIn AD patients, colonization of \u003cem\u003eCandida spp\u003c/em\u003e. in intestinal samples was higher than in VP patients. This phenomenon suggests a disruption of the local mucosal immune system in AD patients, which increases fungal adhesion [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, functional disorders of gastrointestinal motility lead to changes in the metabolic activity of the intestinal microbiota [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported intestinal candidiasis in 30.9% of AD patients, with a predominance of \u003cem\u003eCandida albicans\u003c/em\u003e. In article [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], intestinal candidiasis was observed in all AD patients, who also exhibited dyspeptic disorders. In our study, \u003cem\u003eCandida spp.\u003c/em\u003e proliferation was observed in 61% of AD patients, with marked \u003cem\u003eCandida albicans\u003c/em\u003e colonization in 85% of cases.\u003c/p\u003e\u003cp\u003eThe interaction of the intestinal mycobiome with the immune system ensures the body\u0026rsquo;s homeostasis. Quantitative and qualitative changes in intestinal content are among the triggers of AD and PV. We believe that identifying disease-associated mycobiomes requires a thorough study of population characteristics, geographical features, culinary traditions (such as high consumption of fermented dairy products in the Uzbek region), harmful habits typical for the given population (for example, the use of naswar in the Uzbek population), as well as the adaptive properties of \u003cem\u003eCandida spp.\u003c/em\u003e under different population conditions.\u003c/p\u003e\u003cp\u003eThe pathogenicity of \u003cem\u003eCandida albicans\u003c/em\u003e is explained by its exceptional metabolic adaptability, its ability to switch between yeast and hyphal forms [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and the production of a peptide toxin that activates the cytokine cascade [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Excessive growth of \u003cem\u003eCandida albicans\u003c/em\u003e in the intestine can lead to mycogenic sensitization, which in turn aggravates the course of the underlying disease [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIsolated studies on mycogenic sensitization have been conducted worldwide; however, the detection rates varied [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo date, there is no established algorithm for diagnosing mycogenic sensitization due to the wide spectrum of saprophytic fungal infections. In our study, we detected high levels of \u003cem\u003eCandida albicans\u003c/em\u003e in intestinal samples both in patients with allergic disease \u0026ndash; AD and in patients with an autoimmune disease \u0026ndash; PV. The main criterion for mycogenic sensitization is the detection of specific immunoglobulin E to fungal agents, although in healthy individuals living in regions with high fungal exposure, these indicators may be positive even in the absence of clinical manifestations. Therefore, for the first time, we proposed biological markers for identifying mycogenic sensitization to Candida albicans, the most common mycoallergen: total IgE over 200 IU/mL and IgG Candida albicans above 0.3 ng/mL.\u003c/p\u003e\u003cp\u003eWe observed a statistically significant increase in IgE and IgG Candida albicans in AD patients with mycogenic sensitization, which supports our hypothesis of using these parameters as criteria for mycogenic sensitization. Additionally, the POEM score in this patient group was significantly higher compared to patients without mycogenic sensitization.\u003c/p\u003e\u003cp\u003eIn our study, we observed a non-significant increase in IgG \u003cem\u003eCandida albicans\u003c/em\u003e in PV patients without intestinal candidiasis compared to PV patients with \u003cem\u003eCandida albicans\u003c/em\u003e-induced candidiasis, which may be explained by the immunological mechanisms underlying psoriasis. In psoriasis, there is a shift toward Th1-lymphocytes with hyperproduction of IL-17 and IL-23, which provide antifungal immunity; therefore, we did not observe significant differences between patients with and without mycogenic sensitization [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. At the same time, the PASI score showed a significant difference between these two groups.\u003c/p\u003e\u003cp\u003eWe also did not observe a significant increase in IgG \u003cem\u003eCandida albicans\u003c/em\u003e in PV patients without intestinal candidiasis compared to healthy individuals. This may be explained by the fact that patients with psoriasis have less pronounced disruption of the skin and mucosal barriers than AD patients, and therefore do not exhibit significant \u003cem\u003eCandida\u003c/em\u003e colonization. These findings warrant multicenter studies with larger patient cohorts.\u003c/p\u003e\u003cp\u003eIn our study conducted in Uzbekistan, mycogenic sensitization was detected in 61% of AD patients and 45% of PV patients.\u003c/p\u003e\u003cp\u003eIn our opinion, comprehensive detection of mycogenic sensitization should be included among routine methods in dermatological research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e1. Mycogenic sensitization was observed in 61% of AD cases and 45% of VP cases, with patients exhibiting confirmed intestinal candidiasis and elevated levels of total IgE and IgG \u003cem\u003eCandida albicans.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e2. Patients with mycogenic sensitization had a severe course of AD and VP, as indicated by the POEM and PASI scores.\u003c/p\u003e\n\u003cp\u003e3. These findings highlight the need for routine diagnosis of mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e in patients with skin diseases to optimize therapy.\u003c/p\u003e"},{"header":"LIMITATIONS ","content":"\u003cp\u003eThere are some limitations that may have influenced the statistical ratios in our study. i. Considering the short duration of the study, the patient cohort, although representative, was not large enough to increase the statistical power regarding the prevalence of \u003cem\u003eCandida spp.\u0026nbsp;\u003c/em\u003eii. Limited data on the detection of \u003cem\u003eCandida tropicalis\u003c/em\u003e and \u003cem\u003eCandida krusei\u003c/em\u003e in patients hindered obtaining comprehensive information about the distribution of \u003cem\u003enon-Candida\u003c/em\u003e \u003cem\u003ealbicans\u0026nbsp;\u003c/em\u003especies and their potential clinical significance. Nevertheless, our findings confirmed the predominance of \u003cem\u003eCandida albicans\u003c/em\u003e as the main allergenic species responsible for mycogenic sensitization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eThe study was approved by the Ethics Committee of the Republican specialized scientific and practical medical center of dermatovenerology and cosmetology, Tashkent, Uzbekistan.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e\u003cp\u003eThe authors have nothing to disclose\u003c/p\u003e\u003c/p\u003e"},{"header":"References","content":"\n\u003col\u003e\n\u003cli\u003eCrameri R, Garbani M, Rhyner C, Huitema C. 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London: Wiley; 1996. p. 165\u0026ndash;177.\u003c/li\u003e\n\u003cli\u003eElsner K, Holstein J, Hilke FJ, Blumenstock G, Walker B, Schmidt S, Schaller M, Ghoreschi K, Meier K. Prevalence of \u003cem\u003eCandida\u003c/em\u003e species in psoriasis. \u003cem\u003eMycoses\u003c/em\u003e. 2022;65(2):247\u0026ndash;254. doi:10.1111/myc.13399.\u003c/li\u003e\n\u003cli\u003eCampione E, Cosio T, Pistoia ES, Artosi F, Shumack RG, Borselli C, Rivieccio A, Caputo V, Favaro M, Sorge R, Pica F, Bianchi L, Gaziano R. Prevalence of fungal colonization among patients with psoriasis in difficult-to-treat areas: impact of apremilast on mycotic burden and clinical outcomes. \u003cem\u003eFront Immunol\u003c/em\u003e. 2024;15:1508489. doi:10.3389/fimmu.2024.1508489.\u003c/li\u003e\n\u003cli\u003eNesvizhskiy YuV, Volchkova EV, Filina YuS, Bogdanova EA, Umbetova KT, Pak SG. Razrabotka kompleksnogo podkhoda k terapii infektsii, vyzvannoy gribami roda \u003cem\u003eCandida\u003c/em\u003e [Development of a complex approach to therapy of infections caused by \u003cem\u003eCandida\u003c/em\u003e]. \u003cem\u003eEpidemiologiya i Infektsionnye Bolezni\u003c/em\u003e. 2015;20(1):27\u0026ndash;31. Russian.\u003c/li\u003e\n\u003cli\u003eKorotkiy NG, Narinskaya NM, Belmer SV, Ardatskaya MD. Mikrobioticheskie i motornye rasstroystva zheludochno-kishechnogo trakta pri tyazhelom atopicheskom dermatite u detey [Microbiotic and motor disorders of the gastrointestinal tract in severe atopic dermatitis in children]. \u003cem\u003eEksperimentalnaya i Klinicheskaya Gastroenterologiya\u003c/em\u003e. 2016;125(1):21\u0026ndash;27. Russian.\u003c/li\u003e\n\u003cli\u003eKornisheva VG, Zveryakina EN. 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Virulence factors in fungal pathogens of man. \u003cem\u003eCurr Opin Microbiol\u003c/em\u003e. 2016;32:89\u0026ndash;95. doi:10.1016/j.mib.2016.05.010.\u003c/li\u003e\n\u003cli\u003eChen X, Kokkotou EG, Mustafa N, Bhaskar KR, Sougioultzis S, O\u0026rsquo;Brien M, Pothoulakis C, Kelly CP. \u003cem\u003eSaccharomyces boulardii\u003c/em\u003e inhibits ERK1/2 mitogen-activated protein kinase activation both in vitro and in vivo and protects against \u003cem\u003eClostridium difficile\u003c/em\u003e toxin A-induced enteritis. \u003cem\u003eJ Biol Chem\u003c/em\u003e. 2006;281:24449\u0026ndash;24454. doi:10.1074/jbc.M605200200.\u003c/li\u003e\n\u003cli\u003eAak OV, Frolova EV, Uchevatkina AE, Filippova LV, Sobolev AV, Kotrekhova LP. Mikogennaya sensibizatsiya i stepen tyazhesti atopicheskogo dermatita [Mycogenic sensitization and severity of atopic dermatitis]. \u003cem\u003eProblemy Meditsinskoy Mikologii\u003c/em\u003e. 2013;15(3):10\u0026ndash;13. Russian.\u003c/li\u003e\n\u003cli\u003eBarilo AA, Smirnova SV. The comparative analysis of the spectrum of sensitization to food, pollen and fungal allergens in patients with atopic dermatitis and psoriasis. \u003cem\u003eVopr Pitan\u003c/em\u003e. 2020;89(5):28\u0026ndash;34. doi:10.24411/0042-8833-2020-10063. Russian.\u003c/li\u003e\n\u003cli\u003eKoh CH, Kim BS, Kang CY, Chung Y, Seo H. IL-17 and IL-21: Their Immunobiology and Therapeutic Potentials. \u003cem\u003eImmune Netw\u003c/em\u003e. 2024 Jan 19;24(1):e2. doi: 10.4110/in.2024.24.e2. PMID: 38455465; PMCID: PMC10917578.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"republican center of dermatology","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"atopic dermatitis, psoriasis vulgaris, mycogenic sensitization, Candida spp., Candida albicans, РОЕМ, SCORAD","lastPublishedDoi":"10.21203/rs.3.rs-7641034/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7641034/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: \u003cem\u003eCandida spp. \u003c/em\u003eare common opportunistic microorganisms in the human body. The most prevalent and highly pathogenic species in the mycobiome is\u003cem\u003e Candida albicans, \u003c/em\u003ewhich induces mycogenic sensitization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to determine mycogenic sensitization to \u003cem\u003eCandida albicans\u003c/em\u003e in patients with atopic dermatitis (AD) and psoriasis vulgaris (PV) living in Uzbekistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods: \u003c/strong\u003eWe enrolled 75 patients with AD aged 18 to 67 years and 69 patients with PV aged 23 to 72 years. Mycological examination of intestinal samples (culture on Sabouraud medium) was performed in all patients. Total IgE levels were measured using CLIA, and IgG \u003cem\u003eCandida albicans\u003c/em\u003e was determined by ELISA. In AD patients, the POEM index was assessed, while in PV patients the PASI score was evaluated as well.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Intestinal proliferation of \u003cem\u003eCandida spp. \u003c/em\u003eexceeding 10³ CFU/ml was detected in 61% AD patients (58/75) and 45% PV patients (31/69). Species identification revealed a predominance of \u003cem\u003eCandida albicans\u003c/em\u003e in 85% of AD cases and 77% of PV cases.\u003c/p\u003e\n\u003cp\u003eIn the control group, \u003cem\u003eCandida spp.\u003c/em\u003e were detected in 36.6% (11/30); all isolates were identified as \u003cem\u003eCandida albicans\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eIn AD patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans\u003c/em\u003e, the total IgE level was 232.8 ± 13.9 IU/mL, in AD patients without intestinal candidiasis – 136 ± 9 IU/mL, and in the control group – 90 ±5.5 IU/mL (p\u0026lt;0.001). The mean IgG \u003cem\u003eCandida albicans\u003c/em\u003e in AD patients with intestinal candidiasis was 0.706 ± 0.16 ng/mL, in AD patients without intestinal candidiasis – 0.428±0.07 ng/mL, healthy individuals 0.303 ± 0.09 (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eIn PV patients with intestinal candidiasis caused by \u003cem\u003eCandida albicans\u003c/em\u003e, the total IgE level was 131 ± 9.3 IU/mL, in PV patients without intestinal candidiasis – 121.4 ± 13.2 IU/mL, and in the control group – 90 ± 5.5 IU/mL (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe mean IgG \u003cem\u003eCandida albicans\u003c/em\u003e in PV patients with intestinal candidiasis was higher than in the control group (0.562 ± 0.3 ng/mL vs 0.303 ± 0.09; p\u0026lt;0.001) and PV patients without intestinal candidiasis (0.438 ± 0.18 ng/mL; p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eIn AD patients complicated by mycogenic sensitization, the POEM was 21.5 ± 2.3 points, whereas in AD patients without mycogenic sensitization, the index was 12.2 ± 2.8 points.\u003c/p\u003e\n\u003cp\u003eIn PV patients complicated by mycogenic sensitization, the PASI was 20.7 ± 2.46 points, while in those without mycogenic sensitization, the PASI was 11.4 ± 2.26 points.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Mycogenic sensitization was detected in 61% AD cases and 45% PV cases, accompanied by intestinal candidiasis and elevated levels of total IgE and IgG \u003cem\u003eCandida albicans\u003c/em\u003e. The skin manifestations of AD and PV complicated by mycogenic sensitization were characterized as severe, according to the POEM and PASI indices.\u003c/p\u003e","manuscriptTitle":"Properties of Candida Albicans: Mycogenic Sensitization as a Trigger of Atopic Dermatitis and Psoriasis Vulgaris","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:54:19","doi":"10.21203/rs.3.rs-7641034/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7feb2e61-fa5b-4be5-9eee-3f73c04fe527","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55101994,"name":"Dermatology"}],"tags":[],"updatedAt":"2025-09-23T07:54:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 07:54:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7641034","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7641034","identity":"rs-7641034","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}