Skin diseasesBarrier repair trumps immunology in the pathogenesis and therapy of atopic dermatitis
Section editor:
Michael Roberts – School of Medicine, University of Queensland, Australia
Section snippets
Normal barrier function and barrier abnormalities in atopic dermatitis
The pathogenesis of atopic dermatitis (AD) has been attributed largely to abnormalities in the adaptive immune system, with key roles played by TH1/TH2 cell dysregulation, IgE production, dendritic cell signaling, as well as mast cell hyperactivity, resulting in the pruritic, inflammatory dermatosis that characterizes AD [1]. Accordingly, current therapy has been largely directed towards ameliorating TH2-mediated inflammation and pruritus (e.g. [2]). Instead, evidence is emerging that
Therapeutic implications
Together, the converging pathogenic features described above create a strong rationale for the deployment of specific strategies to restore normal barrier function in AD. When used under nursing supervision, moisturizers have been shown to reduce topical steroid usage [36]. Immunomodulators and anti-inflammatory approaches, which until recently were considered both specific and first-line therapy, should now become ancillary and second-line (back-up approaches). Moreover, because of the
Acknowledgements
We gratefully acknowledge the superb editorial assistance of Ms Joan Wakefield, including her preparation of the graphics. This work was supported by NIH grant AR19098, DOD grant W81XWH-05-2-0094 and the Medical Research Service, Department of Veterans Affairs. No company provided support for this article.
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2018, Journal of Dermatological ScienceCitation Excerpt :It has been described that correction of the barrier abnormality is anti-inflammatory by different mechanisms: down-regulates of signaling mechanisms for barrier repairing that are pro-inflammatory and decreases further penetration of haptens that drive Th2 inflammation. Additionally, the inclusion of free fatty acids impart an acidic pH, which further improves barrier function and blocks activation of proinflammatory serine proteases [44]. Moreover, Schwarz et al. have recently suggested that the topical application of short chain fatty acids (SCFAs) may be used to control inflammatory disorders in the skin due to they have a specific role on skin regulatory T cells.
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