Therapeutic Implications of a Barrier-based Pathogenesis of Atopic Dermatitis.

Abstract

In this review, I first provide relevant background information about normal epidermal barrier structure and function. I then update recent information about how inherited defects in either filaggrin and/or in the serine protease inhibitor, lymphoepithelial Kazal-type inhibitor 1, converge to stimulate the development of atopic dermatitis (AD). Next I explain the multiple mechanisms whereby a primary barrier abnormality in AD can lead to inflammation. Furthermore, I explore how certain acquired stressors, such as a reduced external humidity, high pH soaps/surfactants, psychological stress, as well as secondary Staphylococcus aureus infections initiate or further aggravate AD. Finally, and most importantly, I compare various therapeutic paradigms for AD, highlighting the risks and benefits of glucocorticoids and immunomodulators vs. corrective, lipid replacement therapy.

• Authors: Peter M Elias
• Journal: Annals of dermatology (Ann Dermatol) Vol. 22 Issue 3 Pg. 245-54 (Aug 2010) ISSN: 2005-3894 [Electronic] Korea (South)
• PMID: 20711259 (Publication Type: Journal Article)