Skin Barrier in Atopic Dermatitis

요약문

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that is a major public health burden worldwide. AD is now understood to be a much more heterogeneous disease. Skin barrier defect is the initial step in the development of AD. The epidermis provides a physical and functional barrier for protection of human body. It plays critical roles in preventing environmental allergen penetration into the human body, and responses to microbial pathogens. Many factors including immune dysregulation, filaggrin mutations, deficiency of antimicrobial peptides, skin dysbiosis and olfactory receptors affect skin barrier function. In the early phase of AD, moisturizers may improve skin barrier function and prevent the development of AD. After activation of AD, topical and systemic therapy is needed to reduce immune pathway activation and general inflammation. Targeted microbiome therapy with commensal bacteria is also being developed to correct skin dysbiosis associated with AD. Recently various types of immune therapy such as dupilumab have been developed. Improved identification and characterization of AD phenotypes and endotypes are required to optimize the precision medicine approach to AD.

목차

1. Introduction
 2. Normal skin barrier
 3. Epidermal barrier proteins
 4. Antimicrobial peptides
 5. Lipids
 6. Microbiome
 7. Olfactory receptors
 8. Treatment of AD
 9. Prevention of AD development
 10. References

1. Introduction

 Atopic dermatitis (AD) is the most common chronic inflammatory skin disease[1,2]. It affects up to 20% of children and 5% of adults[1,3-5]. Patients with persistent or severe AD suffer from considerable impairment to their quality of life[2,6,7]. Additionally, AD places a heavy economic burden on patients and their family[8,9]. Moreover, mental health disorders and psychological stress are associated with AD[10,11]. There are numerous methods to control AD because the causes of AD is complicated and multifactorial. The skin is the outermost barrier of the organism and provides a physical and functional barrier for human body, and skin barrier defects are the most important pathologic findings in AD skin[12-14]. Therefore, skin barrier defects have been considered as an initial step in developing AD[4,13]. Recently, investigators demonstrated that multiple factors including immune dysregulation, defects in terminal epithelial differentiation including lack of filaggrin (FLG), antimicrobial peptides (AMPs), altered composition of epidermal lipids, skin microbiome and olfactory receptors (ORs) may affect skin barrier function[2,4,12,15].

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