title: The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies.
abstract: Atopic dermatitis (AD), the most common chronic inflammatory skin disease, is driven by both terminal keratinocyte differentiation defects and strong type 2 immune responses. In contrast to chronic plaque-type psoriasis, AD is now understood to be a much more heterogeneous disease, with additional activation of TH22, TH17/IL-23, and TH1 cytokine pathways depending on the subtype of the disease. In this review we discuss our current understanding of the AD immune map in both patients with early-onset and those with chronic disease. Clinical studies with broad and targeted therapeutics have helped to elucidate the contribution of various immune axes to the disease phenotype. Importantly, immune activation extends well beyond lesional AD because nonlesional skin and the blood component harbor AD-specific inflammatory changes. For this reason, future therapeutics will need to focus on a systemic treatment approach, especially in patients with moderate-to-severe disease.
authors.affiliation: Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Brunner
authors.affiliation: Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Emma
authors.initials: E
authors.lastname: Guttman-Yassky
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo. Electronic address: leungd@njhealth.org.
authors.forename: Donald Y M
authors.initials: DY
authors.lastname: Leung
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016207:Cytokines / Q000378:metabolism; D003876:Dermatitis, Atopic / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007249:Inflammation; D015603:Keratinocytes / Q000502:physiology*; D058990:Molecular Targeted Therapy; D058504:Th17 Cells / Q000276:immunology*; D018418:Th2 Cells / Q000276:immunology*
chemical_list: D000893:Anti-Inflammatory Agents; D016207:Cytokines
keywords: Atopic dermatitis; T helper cell; eczema; immune; keratinocyte; skin immune map; targeted therapy