|
KMID : 1044720120020020070
|
|
Journal of Lifestyle Medicine
2012 Volume.2 No. 2 p.70 ~ p.76
|
|
|
Skin Barrier Related Pathogenesis of Atopic Dermatitis
|
|
Cho Eung-Ho
Yoon Na-Young
|
|
|
Abstract
|
|
|
|
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by severe pruritus and dry skin. Recently, skin barrier defect and abnormal immune reaction were summarized as two main pathogenesis of AD. Congenitally impaired skin barrier, a main etiology of AD can increase allergen permeation through stratum corneum and then induce easy allergen sensitization. Therefore, AD has been considered as a first step of atopic march since it can eventually progress to asthma and allergic rhinitis with aging. In this review, we describe skin barrier related pathogenesis in AD development. First, AD skin shows a deficiency of ceramides which are mostly composed of corneocyte intercellular lipid lamellae, so the novel moisturizers containing physiologic lipid mixture as barrier replacement therapy were born. Second, the imbalance between serine proteases (SP) and SP inhibitors caused by their genetic defects was reported in AD. Continued SP activity due to congenital defect of SP inhibitor disrupts barrier integrity and delays barrier recovery. Third, antimicrobial peptides co-localized with corneocyte intercellular lipid lamellae decrease in AD skin, which causing frequent skin infections such as impetigo and eczema herpeticum. Fourth, loss of function mutation of filaggrin gene is associated with the development of AD presenting early onset, severe symptoms, frequent occurrence of asthma and progression to adult AD, because filaggrin is a key component of the epidermal differentiation complex of the stratum corneum, a major physical barrier. Fifth, tight junction is also congenitally impaired in AD, which also permits easier allergen penetration and sensitization in AD. From above evidences to elucidate the barrier related pathogenesis of AD, we could hypothesize some novel therapeutic and preventive strategies for AD such as acidic moisturizers, serine protease inhibitors, TSLP (thymic stromal lymphopoietin) inhibitors, and Langerhans cell inhibitors.
|
|
|
KEYWORD
|
|
|
Atopic dermatitis, Skin barrier, Ceramide, Serine protease inhibitor, Filaggrin
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|