Highlights
- •Impaired skin barrier function drives the pathophysiology of atopic dermatitis.
- •Defects in skin barrier component genes lead to impaired skin barrier function.
- •Environmental factors may worsen atopic dermatitis through cutaneous exposure.
- •The cutaneous microbiome is an important component of the skin barrier function.
- •Several therapies for atopic dermatitis promote restoration of the skin barrier.
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterized by eczematous
and pruritic skin lesions. In recent decades, the prevalence of AD has increased worldwide,
most notably in developing countries. The enormous progress in our understanding of
the complex composition and functions of the epidermal barrier allows for a deeper
appreciation of the active role that the skin barrier plays in the initiation and
maintenance of skin inflammation. The epidermis forms a physical, chemical, immunological,
neuro-sensory, and microbial barrier between the internal and external environment.
Not only lesional, but also non-lesional areas of AD skin display many morphological,
biochemical and functional differences compared with healthy skin. Supporting this
notion, genetic defects affecting structural proteins of the skin barrier, including
filaggrin, contribute to an increased risk of AD. There is evidence to suggest that
natural environmental allergens and man-made pollutants are associated with an increased
likelihood of developing AD. A compromised epidermal barrier predisposes the skin
to increased permeability of these compounds. Numerous topical and systemic therapies
for AD are currently available or in development; while anti-inflammatory therapy
is central to the treatment of AD, some existing and novel therapies also appear to
exert beneficial effects on skin barrier function. Further research on the skin barrier,
particularly addressing epidermal differentiation and inflammation, lipid metabolism,
and the role of bacterial communities for skin barrier function, will likely expand
our understanding of the complex etiology of AD and lead to identification of novel
targets and the development of new therapies.
Keywords
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Biography
Thomas Luger, MD, is currently Senior Professor, Department of Dermatology, University of Münster. He obtained his MD from the University of Vienna. His clinical interest is focused on inflammatory and autoimmune diseases of the skin, and his main areas of research are the role of cytokines and neuropeptides in the regulation of inflammation and immune tolerance. He is Past-President of the German Society of Dermatology and former Dean of the Medical Faculty of the University of Münster. He is a member of the Austrian Academy of Sciences and the German Academy of Sciences Leopoldina. He is currently Honorary Editor of the journal Experimental Dermatology.
Article info
Publication history
Published online: May 01, 2021
Accepted:
April 29,
2021
Received in revised form:
April 28,
2021
Received:
January 18,
2021
Identification
Copyright
© 2021 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.
