Skin Barrier Dysfunction in Contact Dermatitis and Atopic Dermatitis-Treatment Implications
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Urticaria and Atopic Dermatitis (M Furue and T Nakahara, Section Editors)
Skin Barrier Dysfunction in Contact Dermatitis and Atopic Dermatitis-Treatment Implications H. Aviv, MD1 T. Herzinger, MD2 S. Molin, MD2,* Address 1 Present Address: Department of Dermatology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel *,2 Division of Dermatology, Queens’s University, Kingston, ON, Canada Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Urticaria and Atopic Dermatitis Keywords Epidermal barrier I Cornified envelope I Contact dermatitis I Hand eczema I Atopic dermatitis
Abstract Purpose of review A variety of skin diseases are associated with impaired barrier function. The crucial pillars in therapy of previously mentioned conditions are avoidance of triggers, skin protection and individually adapted medical therapy. Until recently, besides of topical corticosteroids, the treatment options were limited. However, a variety of new therapies of skin barrierrelated skin diseases became available over the last years. Our goal was to investigate new findings and treatment options in skin diseases with barrier dysfunction, emphasizing on contact dermatitis, hand eczema and atopic dermatitis. Recent findings Besides of new relatively nonspecific anti-inflammatory therapies, such as topical calcineurin inhibitors, crisaborole and delgocitinib, also highly specific targeted treatments are currently under investigation, and some already available on the market. Worth mentioning is dupilumab, the first biologic drug approved for treatment of atopic dermatitis, but used also off-label for treatment of hand eczema. There are ongoing trials investigating tralokinumab and lebrikizumab for atopic dermatitis therapy. Anti-IL-31 monoclonal antibodies were reported to improve atopic dermatitis-related pruritus. Summary This review focuses on new findings and treatment options for skin diseases with barrier dysfunction regarding their efficacy, safety profile and mechanism of action.
Urticaria and Atopic Dermatitis (M Furue and T Nakahara, Section Editors)
Introduction The skin is the biggest organ of the human body with a variety of functions. It is composed of three main layers: epidermis, dermis and subcutis. The outermost layer of the epidermis, the stratum corneum, serves as barrier for protection against the environment [1, 2]. The keratinocytes in the epidermis undergo a differentiation process: epidermal stem cells proliferate and form basal cells, further maturation and migration processes lead to spinous, granular and transitional cells, finally forming corneocytes. This process is known as “cornification” [2]. During cornification, cross-linked proteins and lipids embed the terminally differentiated corneocytes and form an insoluble blend [1]. An intact skin barrier is a strong fortress, preventing penetration of irritating substances and microorganisms from the outside; for this feature, it is known as the “outside-in barrier”. Furthermore, it prot
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