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Atopic dermatitis (AD) is a common chronic and relapsing inflammatory skin disease with pruritus that often precedes asthma and allergic rhinitis. Patients with severe or refractory AD and their families experience significant impairment in their life quality. In addition, AD places a heavy economic burden on our society. Recently impaired skin barrier and abnormal immune reaction have been summarized as two main pathogenesis of AD. New insights into the genetics and pathophysiology of AD point to an important role of structural abnormalities in the epidermis as well as immune dysregulation. These insights count not only for this skin disease but also for the development of asthma and allergic rhinitis. Biomarker is an indicator of biological state, which enables both objective measurement and evaluation of normal biological processes, pathogenic processes, or pharmacologic responses to therapeutic intervention. Biomarkers are important in monitoring disease severity, prognosis and treatment responses. In this review, we describe the pathomechanism of AD in the aspects of skin barrier, and highlight the mutations of filaggrin, serine protease, serine protease inhibitors and tight junctions, and the level of ceramides and natural moisturizing factors in stratum corneum as biomarkers of AD. The biomarkers to predict the occurrence and severity of AD based on the mutations of skin barrier related genes are going to be used for applying the preventive and therapeutic strategies against AD, especially in neonates with atopic family history in the near future.
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