clair088

Atopic dermatitis is one of the most common chronic skin diseases among both adults and children.  Although it is often thought of as a skin disease, it also affects many organ systems. There remain a lot of gaps in our knowledge of atopic dermatitis, but researchers are developing a greater appreciation for its complexity of atopic dermatitis and introducing new treatments for this frustrating disease. From an immunologic point of view, atopic dermatitis appears to be a collection of many different variants.  These endotypes are just recently beginning to be described, but involve the various arms of the immune system.  Defects in the innate immune system skew the skin towards inflammation; polarization of T-cells (Th2, Th17, and Th22) lead to further inflammation.  Other cell types, like dendritic cells, eosinophils, and mast cells, play important roles in the development of atopic dermatitis.  The interplay between immune cells and skin barrier proteins, like...

Atopic dermatitis is the most common skin disease in children, affecting up to 1 in 5 children in the United States.  But it doesn’t do it justice to call it just a skin disease.  The itching and scratching leads to a breakdown of the skin, disruptions in sleep, conflicts with parents, and an inability to concentrate at school.  Studies have shown that children with atopic dermatitis have a higher risk of developing mental health disorders like attention-deficit hypersensitivity disorder, anxiety, depression, conduct disorder, and autism. Because atopic dermatitis does not have a single cause and has such far-ranging effects, management can be a challenge.  As LeBovidge and colleagues describe, multidisciplinary interventions are being investigated as a way to help these children ( J Allergy Clin Immunol 2016; 138(2): 325-334 ).  Evaluation by an allergist or dermatologist can help to determine triggers, and education by nurses can help improve adherence and tec...

Some things are so evident that we take them for granted.  Take our skin for example.  We live in our skin and, for the most part, don’t give a second thought about it.  But skin is more than meets the eye.  It is vital for immunity, not only because it protects us from the outside but also because it fine tunes how our immune system responds to the various stimuli it encounters.  For those who have atopic dermatitis, a type of allergic disease that affects the skin leading it to become dry, irritated, and thickened, we see one result of a poor skin function.  In this month’s issue of JACI, Egawa and Kabashima discuss the role of skin barrier dysfunction in atopic dermatitis ( J Allergy Clin Immunol 2016; 138(2): 350-358 ). To understand the skin, we have to think about it in layers.  The topmost layer, called the stratum corneum, is a little like a wall, with flattened cells called corneocytes working like bricks and intercellular lipids functioning a...