title: Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches.
abstract: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus. Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental, and immunologic factors. These factors likely account for the heterogeneity of AD onset and the severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved through early interventions to protect the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention might improve long-term outcomes for AD and reduce the systemic allergen sensitization that leads to associated allergic diseases in the gastrointestinal and respiratory tract.
authors.affiliation: Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo. Electronic address: leungd@njhealth.org.
authors.forename: Donald Y M
authors.initials: DY
authors.lastname: Leung
authors.affiliation: Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Emma
authors.initials: E
authors.lastname: Guttman-Yassky
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D002454:Cell Differentiation; D003876:Dermatitis, Atopic / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D004781:Environmental Exposure / Q000009:adverse effects; D004817:Epidermis / Q000187:drug effects / Q000276:immunology; D000091344:Filaggrin Proteins; D059647:Gene-Environment Interaction; D006566:Herpesviridae Infections / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007231:Infant, Newborn; D063465:Skin Cream / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000209:etiology / Q000517:prevention & control
chemical_list: D000485:Allergens; C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D007073:Immunoglobulin E
keywords: Atopic dermatitis; eczema; filaggrin; immune; infection; skin epithelium