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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.

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  • Authors+Show Affiliations

    ,

    Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo. Electronic address: leungd@njhealth.org.

    Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.

    Source

    MeSH

    Adult
    Allergens
    Animals
    Cell Differentiation
    Dermatitis, Atopic
    Environmental Exposure
    Epidermis
    Gene-Environment Interaction
    Herpesviridae Infections
    Humans
    Immunoglobulin E
    Infant, Newborn
    Skin Cream
    Staphylococcal Infections

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    25282559

    Citation

    Leung, Donald Y M., and Emma Guttman-Yassky. "Deciphering the Complexities of Atopic Dermatitis: Shifting Paradigms in Treatment Approaches." The Journal of Allergy and Clinical Immunology, vol. 134, no. 4, 2014, pp. 769-79.
    Leung DY, Guttman-Yassky E. Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. J Allergy Clin Immunol. 2014;134(4):769-79.
    Leung, D. Y., & Guttman-Yassky, E. (2014). Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. The Journal of Allergy and Clinical Immunology, 134(4), pp. 769-79. doi:10.1016/j.jaci.2014.08.008.
    Leung DY, Guttman-Yassky E. Deciphering the Complexities of Atopic Dermatitis: Shifting Paradigms in Treatment Approaches. J Allergy Clin Immunol. 2014;134(4):769-79. PubMed PMID: 25282559.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Deciphering the complexities of atopic dermatitis: shifting paradigms in treatment approaches. AU - Leung,Donald Y M, AU - Guttman-Yassky,Emma, PY - 2014/08/05/received PY - 2014/08/12/revised PY - 2014/08/12/accepted PY - 2014/10/6/entrez PY - 2014/10/6/pubmed PY - 2015/1/24/medline KW - Atopic dermatitis KW - eczema KW - filaggrin KW - immune KW - infection KW - skin epithelium SP - 769 EP - 79 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 134 IS - 4 N2 - 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. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/25282559/Deciphering_the_complexities_of_atopic_dermatitis:_shifting_paradigms_in_treatment_approaches_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(14)01159-2 DB - PRIME DP - Unbound Medicine ER -